title: New-onset diabetes in HIV-treated adults: predictors, long-term renal and cardiovascular outcomes.
abstract: To determine the incidence and risk factors for developing diabetes mellitus in a cohort of Thai HIV-infected patients on long-term combination antiretroviral therapy (cART).
  
  
  
  Prospective study conducted between July 1996 and 30 April 2015.
  
  
  
  A total of 1748 patients (60% men) who did not have diabetes mellitus prior to ART were assessed twice a year. Incident diabetes mellitus was defined as either having two consecutive fasting glucose levels more than 126 mg/dl, or reporting antidiabetes mellitus medication/diabetes mellitus diagnosis after starting cART. Incidence rates were calculated per 1000 person-year follow-up. Multivariate Cox regression was used to determine risk factors for the development of diabetes mellitus.
  
  
  
  During a median follow-up of 9 years (16 274 person-year of follow-up), 123 patients developed new-onset diabetes mellitus, resulting in an incidence rate of 7.6 (95% confidence interval 6.3-9) per 1000 person-year of follow-up. From the multivariate models, age more than 35 years, male sex, BMI at least 25 kg/m, family history of diabetes, abnormal waist circumference, lipodystrophy and exposure to didanosine were significantly associated with incident diabetes mellitus. The diabetes mellitus group had higher mortality rate (8.1 vs. 4.1%, P = 0.04). A significantly higher proportion diabetes vs. nondiabetes patients developed cardiovascular and cerebrovascular complications (8.9 vs. 3.6%, P = 0.008) or chronic kidney disease stage III (estimated glomerular filtration rate <60 ml/min/1.73 m) (15.3 vs. 1.9%, P < 0.001) over total follow-up.
  
  
  
  In addition to traditional risk factors, lipodystrophy and use of didanosine were strongly associated with development of incident diabetes. Given the higher rate of cardiovascular-cerebrovascular complications and chronic kidney disease among patients with diabetes mellitus, careful assessment and appropriate management of diabetes mellitus are essential.
authors.affiliation: aDivision of Infectious Disease bDivision of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine, Chulalongkorn University cHIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre dDivision of Ambulatory and Hospital Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand eDepartment of Global Health, Academic Medical Center, Amsterdam Institute for Global Health and Development, University of Amsterdam, Amsterdam, The Netherlands fDivision of Cardiovascular Medicine gDivision of Nephrology hDivision of Allergy and Immunology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Opass
authors.initials: O
authors.lastname: Putcharoen
authors.forename: Lalita
authors.initials: L
authors.lastname: Wattanachanya
authors.forename: Jiratchaya
authors.initials: J
authors.lastname: Sophonphan
authors.forename: Sarawut
authors.initials: S
authors.lastname: Siwamogsatham
authors.forename: Vorapot
authors.initials: V
authors.lastname: Sapsirisavat
authors.forename: Sivaporn
authors.initials: S
authors.lastname: Gatechompol
authors.forename: Supalak
authors.initials: S
authors.lastname: Phonphithak
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Kerr
authors.forename: Pairoj
authors.initials: P
authors.lastname: Chattranukulchai
authors.forename: Yingyos
authors.initials: Y
authors.lastname: Avihingsanon
authors.forename: Kiat
authors.initials: K
authors.lastname: Ruxrungtham
authors.forename: Anchalee
authors.initials: A
authors.lastname: Avihingsanon
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D044466:Asian People; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D016049:Didanosine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000503:physiopathology*; D039682:HIV-Associated Lipodystrophy Syndrome / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D056128:Obesity, Abdominal / Q000150:complications* / Q000503:physiopathology; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000209:etiology / Q000517:prevention & control*; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D012307:Risk Factors; D013785:Thailand; D016896:Treatment Outcome
chemical_list: D018894:Reverse Transcriptase Inhibitors; D016049:Didanosine