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As noted in Issues 27/28
of the HIV ReSource
Review, glucose abnormalities in HIV-positive people are a common metabolic
complication of highly active antiretroviral therapy (HAART). (1, 2) Type
2 (non-insulin dependent or adult-onset) diabetes is closely associated
with central abdominal fat. (1) A recent study of elderly individuals with
hyperinsulinemia reveals that even people with normal body weight may be
at risk for metabolic abnormalities, including Type 2 diabetes, if they
have an excessive amount of muscle fat or visceral abdominal fat. (3) Liver
fat accumulation may play a role in the development of insulin resistance
in patients treated with protease inhibitors (PIs) as insulin resistance
syndrome in HAART patients with lipodystrophy is related to the extent
of fat accumulation in the liver rather than in the intraabdominal region.
(4)
Researchers investigating
the role of dietary factors in the development of Type 2 diabetes found
that recently diagnosed and undiagnosed diabetics consume more total fat
and animal fat and fewer carbohydrates. (5) These multinational, multicenter
study participants were more likely to have sedentary professions and exercised
less than control groups of nondiabetic subjects. Eating highly refined
foods also hastens the development of glucose intolerance. Montonen and
others found the intake of whole grains significantly inversely associated
with risk of Type 2 diabetes. (6)
Recommendations from the
U.S. Preventive Services Task Force include screening people with high
blood pressure or high cholesterol for Type 2 diabetes mellitus. (7) A
summary
of these recommendations for patients is on the Internet. Besides increasing
age, and weight, PI use is reported to be an independent risk factor for
self-reported diabetes so routine screening of patients on HAART is especially
warranted. (8) Along with other guidelines, in 2002, a panel chosen by
the International AIDS Society-USA recommended routine assessment and monitoring
of glucose and lipid levels to prevent acute illness and mitigate long-term
risks in HIV-positive people. (9) Limiting the use of PIs in people with
glucose abnormalities or in those who have relatives with diabetes may
help to decrease the incidence of Type 2 diabetes. The panel recommended
that physicians check glucose levels of people before starting HAART, three
to six months after starting the antiretroviral regimen and at least once
a year after the first year. If medications are necessary to improve insulin
sensitivity, the panel prefers the use of metformin (Glucophage - highlighted
in the Nov/Dec 2000 HIV ReSource Review) or other thiazolidinediones.
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