Individual-Level and Clinic-Level Factors Associated With Achieving Glycemic Control in a Large Cohort of People With HIV in Care-Washington, DC.

Autor:	Happ LP; Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC., Monroe AK; Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC., Young HA; Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC., Ma Y; Department of Biostatistics and Bioinformatics, Milken Institute School of Public Health at the George Washington University, Washington, DC; and., Greenberg AE; Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC., Horberg MA; Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD., Castel AD; Department of Epidemiology, Milken Institute School of Public Health at the George Washington University, Washington, DC.
Jazyk:	angličtina
Zdroj:	Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] 2020 Sep 01; Vol. 85 (1), pp. 113-122.
DOI:	10.1097/QAI.0000000000002416
Abstrakt:	Background: Optimal management of noncommunicable diseases, including diabetes mellitus (DM), is crucially important as people with HIV (PWH) live longer with antiretroviral therapy. Our objective was to assess patient-level and clinic-level factors associated with achieving hemoglobin A1c (HbA1c) ≤7.0% among PWH and DM. Setting: The DC Cohort, an observational clinical cohort of PWH, followed from 2011 to 2019 at 12 sites in Washington, DC. Methods: Among PWH with diagnosed DM and elevated HbA1c (>7.0%), we examined the association between achieving HbA1c ≤7.0% and demographic and clinical factors, including time-updated medication data, and clinic-level factors related to services and structure. A multilevel marginal extended Cox regression model was generated to identify factors associated with time to HbA1c ≤7.0%. Results: Over half (52.3%) of 419 participants achieved HbA1c ≤7.0%. Individual-level factors associated with HbA1c ≤7.0% included a diagnosis of DM after enrollment and a longer time since HIV diagnosis [hazard ratio (HR) = 2.65 and 1.13, P < 0.05 for both]. Attending a clinic with an endocrinologist was associated with the outcome [adjusted HR (aHR) = 1.41 95% confidence interval (CI): (1.01 to 1.97)]. In addition, comparing clinics that treat everyone, refer everyone or have a mix of treating and referring, showed an association between attending a clinic that treats everyone [aHR = 1.52 95% CI: (1.21 to 1.90)] or a clinic that refers everyone [aHR = 2.24 95% CI: (1.63 to 3.07)] compared with clinics with a mix in achieving glycemic control. Conclusion: Multiple factors are associated with achieving glycemic control in an urban cohort of PWH. Determining if specific services or structures improve DM outcomes may improve health outcomes for PWH and DM.
Databáze:	MEDLINE
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