Unmasking a silent killer: prevalence of diagnosedand undiagnosed diabetes mellitus among people livingwith HIV in rural South Africa

Abstract

Objectives: To document the prevalence of impaired glucose tolerance (IGT) andundiagnosed diabetes mellitus (DM) and to identify factors associated with undiag-nosed DM in people living with HIV (PLWH).Methods: Cross-sectional study performed at Ndlovu Medical Center, Limpopo,South Africa including PLWH aged ≥18 years. Between August and November 2017,356 HIV-positive participants were included. Information was collected on socio-demographics, DM symptoms and risk factors for DM. IGT and DM were diagnosedusing random plasma glucose and/or HbA1c. Factors associated with undiagnosedDM were assessed by comparing participants with newly diagnosed DM to partici-pants without DM.Results: IGT was diagnosed in 172 (48.3%) participants. Twenty-nine (8.1%) partici-pants met the definition of DM, of whom 17 (58.6%) were newly diagnosed. Com-pared to participants without DM, participants with DM were on average 5 yearsolder, were more likely to have a positive family history for DM, were less physicallyactive and had higher systolic blood pressure, body mass index and waist circumfer-ence. Factors associated with undiagnosed DM included age ≥45 years (odds ratio[OR] = 3.59) and physical inactivity (OR = 3.17).Conclusions: The prevalence of IGT and DM among PLWH is high and more thanhalf of DM cases were undiagnosed. Regular screening for DM in PLWH is recom-mended, especially in an ageing population with additional cardiovascular disease riskfactors.