Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC.
Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health at the George Washington University, Washington, DC; and.
J Acquir Immune Defic Syndr. 2020 Sep 1;85(1):113-122. doi: 10.1097/QAI.0000000000002416.
Optimal management of noncommunicable diseases, including diabetes mellitus (DM), is crucially important as people with HIV (PWH) live longer with antiretroviral therapy. Our objective was to assess patient-level and clinic-level factors associated with achieving hemoglobin A1c (HbA1c) ≤7.0% among PWH and DM.
The DC Cohort, an observational clinical cohort of PWH, followed from 2011 to 2019 at 12 sites in Washington, DC.
Among PWH with diagnosed DM and elevated HbA1c (>7.0%), we examined the association between achieving HbA1c ≤7.0% and demographic and clinical factors, including time-updated medication data, and clinic-level factors related to services and structure. A multilevel marginal extended Cox regression model was generated to identify factors associated with time to HbA1c ≤7.0%.
Over half (52.3%) of 419 participants achieved HbA1c ≤7.0%. Individual-level factors associated with HbA1c ≤7.0% included a diagnosis of DM after enrollment and a longer time since HIV diagnosis [hazard ratio (HR) = 2.65 and 1.13, P < 0.05 for both]. Attending a clinic with an endocrinologist was associated with the outcome [adjusted HR (aHR) = 1.41 95% confidence interval (CI): (1.01 to 1.97)]. In addition, comparing clinics that treat everyone, refer everyone or have a mix of treating and referring, showed an association between attending a clinic that treats everyone [aHR = 1.52 95% CI: (1.21 to 1.90)] or a clinic that refers everyone [aHR = 2.24 95% CI: (1.63 to 3.07)] compared with clinics with a mix in achieving glycemic control.
Multiple factors are associated with achieving glycemic control in an urban cohort of PWH. Determining if specific services or structures improve DM outcomes may improve health outcomes for PWH and DM.
随着抗逆转录病毒疗法的应用，艾滋病毒（HIV）感染者（PWH）的寿命得以延长，因此，对包括糖尿病（DM）在内的非传染性疾病进行最佳管理至关重要。我们的目的是评估与 PWH 和 DM 患者的血红蛋白 A1c（HbA1c）≤7.0%相关的患者水平和临床水平因素。
DC 队列，是一个观察性的 PWH 临床队列，于 2011 年至 2019 年在华盛顿特区的 12 个地点进行随访。
在患有诊断性 DM 和 HbA1c 升高（>7.0%）的 PWH 中，我们检查了实现 HbA1c≤7.0%与人口统计学和临床因素之间的关联，包括时间更新的药物数据，以及与服务和结构相关的临床水平因素。生成多水平扩展扩展 Cox 回归模型，以确定与 HbA1c≤7.0%相关的时间因素。
在 419 名参与者中，超过一半（52.3%）实现了 HbA1c≤7.0%。与 HbA1c≤7.0%相关的个体水平因素包括入组后诊断为 DM 和 HIV 诊断后时间较长[风险比（HR）分别为 2.65 和 1.13，均<0.05]。在有内分泌科医生的诊所就诊与该结果相关[调整后的 HR（aHR）=1.41 95%置信区间（CI）：（1.01 至 1.97）]。此外，比较了治疗所有人、将所有人转诊或同时进行治疗和转诊的诊所，发现与治疗所有人的诊所就诊[aHR=1.52 95%CI：（1.21 至 1.90）]或转诊所有人的诊所就诊[aHR=2.24 95%CI：（1.63 至 3.07）]与同时有治疗和转诊的诊所相比，与实现血糖控制相关。
多种因素与城市 PWH 人群实现血糖控制相关。确定特定服务或结构是否能改善 DM 结局，可能会改善 PWH 和 DM 的健康结局。
