Trends in diabetes incidence and associated risk factors among people living with HIV in the current treatment era, 2008-2018

People with HIV (PWH) have an increased risk for diabetes mellitus. Our objectives were to characterize the prevalence and incidence of diabetes in a cohort of people with HIV (PWH), and to evaluate both traditional and HIV-specific risk factors contributing to incident diabetes diagnoses. We conducted a retrospective study of a Southeastern US academic HIV clinic. All PWH age > 18 years of age who attended at least two clinic visits between 2008 and 2018 were evaluated to assess time to diabetes incidence. Laboratory, demographic, clinical, medication and diagnoses data were extracted from the Clinic EMR. Diabetes was defined when at least two of the following three criteria were met: (1) laboratory data consistent with a diagnosis as defined by the ADA SOC (Hgb A1C ≥ 6.5% and/or 2 glucose results >200 mg/dl (at least 30 days apart)), (2) diagnosis of diabetes in the EMR, or (3) exposure to diabetes medication. Time to Diabetes incidence was computed from the entire clinic population for each study year. Univariate Cox proportional hazard models were developed to evaluate associations between each baseline factor and time to DM. Multivariable Cox proportional hazard regression models with time-dependent covariates were created to evaluate the independent association between significant parameters from univariate analyses and time to incident DM. From 4113 PWH included in the analysis, we identified 252 incident cases of diabetes. In multivariable analysis, BMI classification, liver disease, steroid exposure, and use of Integrase Inhibitors were associated with incident diabetes. Additional associated factors included lower CD4 cell counts, duration of HIV infection, exposure to non-statin lipid lowering therapy, and dyslipidemia. Incident diabetes rates are increasing at an alarming rate among PWH. Diabetes prevalence increased from 8.8% in 2008 to 14% in 2018. Both traditional and HIV-related risk factors, particularly body weight, steroid exposure, and use of Integrase Inhibitors, were associated with incident diabetes. Notably, several of the risk factors identified are modifiable and should be targeted for intervention. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the National Institute of Allergy and Infectious Disease at the National Institutes of Health through the UAB Center for AIDS Research [grant number P30-AI27767]. A.C. and A.L.W. were also supported by award numbers P30-DK056336 and P30-DK079626 from the National Institute of Diabetes and Digestive and Kidney Diseases. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The University of Alabama at Birmingham Institutional Review Board (IRB) approved this study nested in the UAB 1917 Clinic Cohort. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors