Glycated haemoglobin in diabetic women with and without HIV infection: data from the Women's Interagency HIV Study.
BACKGROUND
Limited data suggest that glycated haemoglobin (haemoglobin A1c; A1C) values might not reflect glycaemic control accurately in HIV-infected individuals with diabetes.


METHODS
We evaluated repeated measures of paired fasting glucose and A1C values in 315 HIV-infected and 109 HIV-uninfected diabetic participants in the Women's Interagency HIV Study. Generalized estimating equations used log A1C as the outcome variable, with adjustment for log fasting glucose concentration in all models.


RESULTS
An HIV-infected woman on average had 0.9868 times as much A1C (that is, 1.32% lower; 95% confidence interval 0.9734-0.9904) as an HIV-uninfected woman with the same log fasting glucose concentration. In multivariate analyses, HIV serostatus was not associated, but White, other non-Black race, and higher red blood cell mean corpuscular volume (MCV) were statistically associated with lower A1C values. Use of diabetic medication was associated with higher A1C values. In multivariate analyses restricted to HIV-infected women, White and other race, higher MCV, and HCV viraemia were associated with lower A1C values, whereas older age, use of diabetic medications and higher CD4(+) T-cell count were associated with higher A1C values. Use of combination antiretroviral therapy, protease inhibitors, zidovudine, stavudine or abacavir was not associated with A1C values.


CONCLUSIONS
A1C values were modestly lower in HIV-infected diabetic women relative to HIV-uninfected diabetic women after adjustment for fasting glucose concentration. The difference was abrogated by adjustment for MCV, race and diabetic medication use. Our data suggest that in clinical practice A1C gives a reasonably accurate refection of glycaemic control in HIV-infected diabetic women.
Glesby
Marshall J
MJ
Department of Medicine, Weill Cornell Medical College, New York, NY, USA. mag2005@med.cornell.edu
Hoover
Donald R
DR
Shi
Qiuhu
Q
Danoff
Ann
A
Howard
Andrea
A
Tien
Phyllis
P
Merenstein
Dan
D
Cohen
Mardge
M
Golub
Elizabeth
E
Dehovitz
Jack
J
Nowicki
Marek
M
Anastos
Kathryn
K
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001786:Blood Glucose / Q000032:analysis*; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000378:metabolism; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008875:Middle Aged
D001786:Blood Glucose; D006442:Glycated Hemoglobin