Glycemic Control Among People Living with Diabetes and Human Immunodeficiency Virus in Ethiopia: Leveraging Clinical Care for the Looming  Co-Epidemics

Abstract

Background

Antiretroviral therapy has decreased human immunodeficiency virus related mortality. However, the incidence of diabetes mellitus is increasing among people living with human immunodeficiency virus and adds complexity to the standards of care.

Objective

The study was aimed to determine the glycemic control and delivery of clinical care among people living with diabetes and human immunodeficincy virus in Ethiopia.

Methods

A comparative prospective cohort study was conducted among patients living with diabetes at follow-up clinics of Jimma Medical Center in two study arms. The first arm was people living with diabetes and human immunodeficiency virus. The second arm was human immunodeficiency virus negative patients living with diabetes. The expanded English version of the summary of diabetes self-care activities scale was used to measure self-care behaviors. In order to identify the predictors of glycemic control, multivariable Cox regression analysis was used. Statistical significance at p-value ≤0.05 was considered.

Results

A total of 297 eligible participants were followed for one year, with a mean age of 44.35±12.55 years. Males accounted for 55.9%. After one year of follow-up, 61.9% of diabetes people living with human immunodeficiency virus, and 49% of human immunodeficiency virus-negative patients with diabetes poorly met blood glucose target (p=0.037). Female gender [AHR: 2.72; 95% CI (1.21–5.72)], age >31 years [AHR: 2.48; 95% CI (1.34–11.01)], increased waist circumference [AHR: 3.64; 95% CI (2.57–16.12)], overweight [AHR: 3.63; 95% CI (1.65–22.42)], chronic disease comorbidity [AHR: 2.02; 95% CI (1.44–2.84)], human immunodeficiency virus infection [AHR: 3.47; 95% CI (2.03–23.75)], living longer with diabetes (>5 years) [AHR: 3.67; 95% CI (3.26–4.14)] showed a higher risk of blood sugar control failure and were independent predictors of uncontrolled glycemia. Tuberculosis infection increased the risk of uncontrolled blood sugar among people living with diabetes and human immunodeficency virus[AHR:3.82;95% CI(2.86-5.84].

Conclusion

Significant gaps were observed in achieving the recommended glycemic target and involvement of patients on self-care care behavior in the study area. The co-occurrence of tuberculosis, human immunodeficiency virus, and diabetes is triple trouble needing special attention in their management. It is high time to leverage the clinical care of the looming co-epidemics through chronic comprehensive care clinic.

Keywords:

• human immunodeficiency virus
• glycemic control
• treatment outcome
• self-care behavior

Abbreviations

ADA, American Diabetes Association; AHR, adjusted hazard ratio; ART, antiretroviral therapy; BMI, body mass index; CD4, cluster of differentiation 4; CHR, crude hazard ratio; CI, confidence interval; DM, diabetes mellitus; HIV, human immunodeficiency virus; HR, hazard ratio; HAART, highly active antiretroviral therapy; JMC, Jimma Medical Center; NNRTIs, non-nucleoside reverse transcriptase inhibitors; PLHIV, people living with HIV; PI, protease inhibitor; NRTIs, nucleoside reverse transcriptase inhibitors; SD, standard deviation; SDSCA, summary of diabetes self-care activities; TB, tuberculosis; WC, waist circumference; WHO, World Health Organization.

Data Sharing Statement

The data sets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Ethical Approval

Ethical clearance and approval were obtained from the institution review board (IRB) of Jimma University with the reference number of IHRPGC/2098/10. It was based on the 1964 Helsinki declaration and its later amendments or comparable ethical standards. All study participants provided written informed consent.

Consent

Not applicable. No person’s details, images, or videos were used in this study.

Acknowledgments

We thank Jimma University for supporting the study. We are grateful to staff members of chronic care clinics of JMC, data collectors, and study participants for their cooperation in the success of this study.

Author Contributions

All authors made a significant contribution to the work reported; in the conception, study design, execution, acquisition of data, analysis, and interpretation, they all took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted, and agree to be accountable for all aspects of the work.

Disclosure

The authors declared that they have no competing interests.

Additional information

Funding

The only funder for the study was Jimma University. The funding body did not have any role in study design, data collection, and data analysis, interpretation of data, or in writing the manuscript.