Tips From This Interview on Diabetes Management in People With HIV
The impact of HIV itself on diabetes risk remains controversial, but there is no question that HIV populations carry a heavy burden of traditional diabetes risk factors.
The hemoglobin A1c test underestimates blood glucose in people with HIV. A hemoglobin A1c of 6.5% in an HIV patient may be equivalent to 7.0% in an HIV-uninfected patient, so this test should probably not be used to screen for diabetes in people with HIV.
Hemoglobin A1c targets for diabetes treatment should probably be individualized, with more stringent targets (6.0% to 6.5%) for younger people without comorbidities, and looser targets (7.0% to 8.0%) for older people with comorbidities and thus a higher risk of hypoglycemia.
High mean corpuscular volume (MCV) is a strong predictor of hemoglobin A1c/glycemia discordance. If I see an MCV in the high 90s or over 100 in an HIV-infected patient, I know not to trust the HbA1c too much.
The dose of saxagliptin, an oral hypoglycemic agent, may need to be lowered to 2.5 mg when given with a potent CYP3A4 inhibitor.5
The HIV integrase inhibitor dolutegravir increases metformin plasma exposure and may necessitate downward dose adjustment of metformin.6
Whether an HIV patient with diabetes should be referred to an endocrinologist depends on the provider's comfort level in managing diabetes. Bear in mind that specialists have an array of resources that can improve diabetes management, like certified diabetes educators and nutritionists.