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Senior investigator Dr. Colleen Hadigan stated that, “For HIV-infected patients with diabetes on antiretroviral therapy, hemoglobin A1c may misrepresent their glycemic control and result in sub-optimal medical management of their diabetes…. In these cases careful review of home glucose monitoring or use of fructosamine may be preferred.”
Dr. Hadigan of the National Institutes of Health, Bethesda, Maryland and colleagues note that diabetes is increasingly recognized in HIV. Current management guidelines are similar to those in the general population, but there is some evidence that HIV may alter the relationship between A1c and glucose levels.
To investigate further, the researchers compared 77 HIV patients with Type 2 diabetes and 23 with fasting hyperglycemia to 200 similar Type 2 diabetics without HIV.
Multiplying A1c by standard factors underestimated serum glucose levels by a mean of 29 mg/dL in the HIV group compared to controls.
Current nucleoside reverse transcriptase inhibitor (NRTI) use, higher mean corpuscular volume and hemoglobin, and lower HIV RNA and haptoglobin were associated with greater A1c-glucose discordance.
On multivariate analysis, only NRTI use (in particular, abacavir) and mean corpuscular volume were independent predictors of discordance.
Fructosamine, the researchers found, “reliably predicted glucose in our cohort and was not influenced by mean corpuscular volume or current abacavir or NRTI use.”
“Fructosamine may be an appropriate alternative for assessment of glycemia in this context,” they point out.
Dr. Hadigan concluded that “as the field of endocrinology moves towards the use of hemoglobin A1c for screening and diagnosis of diabetes, it will be important to keep in mind that HIV-infected patients with new onset diabetes may be missed using this approach.”