title: Comparative Effectiveness of Diabetic Oral Medications Among HIV-Infected and HIV-Uninfected Veterans.
abstract: Type 2 diabetes is increasingly common in HIV-infected individuals. The objective of this study was to compare the glycemic effectiveness of oral diabetic medications among patients with and without HIV infection.
  
  
  
  A longitudinal cohort study was conducted among HIV-infected and uninfected veterans with type 2 diabetes initiating diabetic medications between 1999 and 2010. Generalized estimating equations were used to compare changes in hemoglobin A1c(HbA1c) through the year after medication initiation, adjusting for baseline HbA1clevel and clinical covariates. A subanalysis using propensity scores was conducted to account for confounding by indication.
  
  
  
  A total of 2,454 HIV-infected patients and 8,892 HIV-uninfected patients initiated diabetic medications during the study period. The most commonly prescribed medication was metformin (n = 5,647, 50%), followed by a sulfonylurea (n = 5,554, 49%) and a thiazolidinedione (n = 145, 1%). After adjustment for potential confounders, there was no significant difference in the change in HbA1clevel among the three groups of new users. HIV infection was not significantly associated with glycemic response (P = 0.24). Black and Hispanic patients had a poorer response to therapy compared with white patients, with a relative increase in HbA1clevel of 0.16% (95% CI 0.08, 0.24) [1.7 mmol/mol (0.9, 2.6)] (P < 0.001) and 0.25% (0.11, 0.39) [2.7 mmol/mol (1.2, 4.3)] (P = 0.001), respectively.
  
  
  
  We found that glycemic response was independent of the initial class of diabetic medication prescribed among HIV-uninfected and HIV-infected adults with type 2 diabetes. The mechanisms leading to poorer response among black and Hispanic patients, who make up a substantial proportion of those with HIV infection and type 2 diabetes, require further investigation.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA jennifer.han@uphs.upenn.edu.|Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Han
authors.affiliation: Department of Internal Medicine, West Haven VA Medical Center, West Haven, CT.
authors.forename: Kirsha
authors.initials: K
authors.lastname: Gordon
authors.affiliation: Department of Internal Medicine, West Haven VA Medical Center, West Haven, CT.|Yale School of Nursing, Yale University, New Haven, CT.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Womack
authors.affiliation: Section of Infectious Diseases, George Washington University School of Medicine and Health Sciences, Washington, DC.|Department of Medicine, Washington DC VA Medical Center, Washington, DC.
authors.forename: Cynthia L
authors.initials: CL
authors.lastname: Gibert
authors.affiliation: Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.|Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
authors.forename: David A
authors.initials: DA
authors.lastname: Leaf
authors.affiliation: Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA.|Division of Infectious Diseases, Atlanta VA Medical Center, Atlanta, GA.
authors.forename: David
authors.initials: D
authors.lastname: Rimland
authors.affiliation: Infectious Diseases Section, Michael E. DeBakey VA Medical Center, Houston, TX.|Department of Medicine, Baylor College of Medicine, Houston, TX.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Rodriguez-Barradas
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.|Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.|Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Bisson
mesh_terms: D000328:Adult; D001741:Black or African American; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D057186:Comparative Effectiveness Research; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D015658:HIV Infections / Q000097:blood / Q000150:complications*; D006630:Hispanic or Latino; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008137:Longitudinal Studies; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D013453:Sulfonylurea Compounds / Q000627:therapeutic use; D045162:Thiazolidinediones / Q000627:therapeutic use; D014728:Veterans; D044465:White People
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D008687:Metformin; D013453:Sulfonylurea Compounds; D045162:Thiazolidinediones; C089946:2,4-thiazolidinedione