Diabetes Mellitus and Insulin Resistance

Sudipa Sarkar, M.D., Todd T. Brown, M.D.
Diabetes Mellitus and Insulin Resistance is a topic covered in the Johns Hopkins HIV Guide.

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CLINICAL

  • Insulin resistance (IR) common in people with HIV (PWH) on ART, especially older PWH.[15][14]
  • Diabetes mellitus (DM) also common, with a prevalence that is at least 2x higher than in general population.[11]
  • IR also caused by fat accumulation (lipodystrophy). In general population (and presumably in PWH), IR increases risk for cardiovascular disease (CVD).[10]
  • Risk factors for IR/DM: ectopic fat accumulation, peripheral lipoatrophy, family Hx of DM, obesity, age, HCV, black/Hispanic race.[11][10][26]
  • Consider role of other medications: corticosteroids, growth hormone, megestrol acetate, immunosuppressants, atypical antipsychotics.[20][17]
  • Older PIs (IDV, full-dose RTV) have marked effects on IR.[34][24] Of the current PIs, LPV/r > DRV/r and ATV/r.[28][16] Boosting dose of RTV has not been shown to effect IR in people without HIV.[19]
  • No difference seen in HOMA-IR in participants treated with the integrase inhibitors (INSTI) raltegravir versus ATV/r or DRV/r.[12]

-- To view the remaining sections of this topic, please or --

CLINICAL

  • Insulin resistance (IR) common in people with HIV (PWH) on ART, especially older PWH.[15][14]
  • Diabetes mellitus (DM) also common, with a prevalence that is at least 2x higher than in general population.[11]
  • IR also caused by fat accumulation (lipodystrophy). In general population (and presumably in PWH), IR increases risk for cardiovascular disease (CVD).[10]
  • Risk factors for IR/DM: ectopic fat accumulation, peripheral lipoatrophy, family Hx of DM, obesity, age, HCV, black/Hispanic race.[11][10][26]
  • Consider role of other medications: corticosteroids, growth hormone, megestrol acetate, immunosuppressants, atypical antipsychotics.[20][17]
  • Older PIs (IDV, full-dose RTV) have marked effects on IR.[34][24] Of the current PIs, LPV/r > DRV/r and ATV/r.[28][16] Boosting dose of RTV has not been shown to effect IR in people without HIV.[19]
  • No difference seen in HOMA-IR in participants treated with the integrase inhibitors (INSTI) raltegravir versus ATV/r or DRV/r.[12]

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Last updated: March 7, 2020