Diabetes Mellitus and Insulin Resistance
- Insulin resistance (IR) common in people with HIV (PWH) on ART, especially older PWH.
- Diabetes mellitus (DM) also common, with a prevalence that is at least 2x higher than in general population.
- IR also caused by fat accumulation (lipodystrophy). In general population (and presumably in PWH), IR increases risk for cardiovascular disease (CVD).
- Risk factors for IR/DM: ectopic fat accumulation, peripheral lipoatrophy, family Hx of DM, obesity, age, HCV, black/Hispanic race.
- Consider role of other medications: corticosteroids, growth hormone, megestrol acetate, immunosuppressants, atypical antipsychotics.
- Older PIs (IDV, full-dose RTV) have marked effects on IR. Of the current PIs, LPV/r > DRV/r and ATV/r. Boosting dose of RTV has not been shown to effect IR in people without HIV.
- No difference seen in HOMA-IR in participants treated with the integrase inhibitors (INSTI) raltegravir versus ATV/r or DRV/r.
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Last updated: March 7, 2020
Sarkar, Sudipa, and Todd T Brown. "Diabetes Mellitus and Insulin Resistance." Johns Hopkins HIV Guide, 2020. Johns Hopkins Guides, www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545106/all/Diabetes_Mellitus_and_Insulin_Resistance.
Sarkar S, Brown TT. Diabetes Mellitus and Insulin Resistance. Johns Hopkins HIV Guide. 2020. https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545106/all/Diabetes_Mellitus_and_Insulin_Resistance. Accessed June 9, 2023.
Sarkar, S., & Brown, T. T. (2020). Diabetes Mellitus and Insulin Resistance. In Johns Hopkins HIV Guide https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545106/all/Diabetes_Mellitus_and_Insulin_Resistance
Sarkar S, Brown TT. Diabetes Mellitus and Insulin Resistance [Internet]. In: Johns Hopkins HIV Guide. ; 2020. [cited 2023 June 09]. Available from: https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_HIV_Guide/545106/all/Diabetes_Mellitus_and_Insulin_Resistance.
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