背景:乌干达卫生部建议对dolutegravir进行前六个月的频繁血糖监测,在患有糖尿病前期(pre-DM)的HIV(PWH)患者中。我们试图确定与血糖正常的患者相比,在dolutegravir开始的糖尿病前期PWH在48周时是否有更差的血糖结果。
方法:在这项配对队列研究中,我们比较了基线时44PWH与DM前期和88PWH与正常血糖.主要结果是两组之间从基线到第48周的平均空腹血糖(FBG)和从基线到第36周的2小时血糖(2hBG)的变化。
结果:在血糖正常的PWH中,FBG显着增加(FBG(FBG)的平均变化:3.9mg/dl,95%置信区间(95%CI):(2.2,5.7),p值(p)=<0.0001),并且在具有预DM的患者中降低(FBG:-6.1mg/dl,95CI(-9.1,-3.2),p=<0.0001)在48周时。在两组中,2hBG均显着低于基线,在12周时,DM前期患者的降低幅度更大(2hBG(a2hBG)平均下降的校正差异:-19.69mg/dl,95CI(-30.19,-9.19),p=<0.0001)和36周(a2hBG:-19.97mg/dl,95CI(-30.56,-9.39),p=<0.0001)。
结论:我们证明了乌干达抗逆转录病毒治疗初治PWH伴糖尿病前期患者在杜鲁特韦治疗48周内空腹血糖和糖耐量均有持续改善。在dolutegravir的前六个月加强对这些患者的血糖监测可能是不必要的。
BACKGROUND: The Uganda ministry of Health recommends frequent blood glucose monitoring for the first six months on dolutegravir, in people with HIV (PWH) having pre-diabetes mellitus (pre-DM). We sought to determine if indeed PWH with pre-diabetes started on dolutegravir had worse blood glucose outcomes at 48 weeks compared to those with normal blood glucose.
METHODS: In this matched cohort study, we compared 44 PWH with pre-DM and 88 PWH with normal blood glucose at baseline. The primary outcome was change in mean fasting blood glucose (FBG) from baseline to week 48 and 2-hour blood glucose (2hBG) from baseline to week 36 compared between the two groups.
RESULTS: There was significant increase in FBG in PWH with normal blood glucose (mean change in FBG(FBG): 3.9 mg/dl, 95% confidence interval (95% CI): (2.2, 5.7), p value (p) = < 0.0001) and decrease in those with pre-DM (FBG: -6.1 mg/dl, 95%CI (-9.1, -3.2), p = < 0.0001) at 48 weeks. 2hBG was significantly lower than at baseline in both groups with the magnitude of reduction larger in those with pre-DM at 12 weeks (adjusted differences in mean drop in 2hBG (a2hBG): -19.69 mg/dl, 95%CI (-30.19, -9.19), p = < 0.0001) and 36 weeks (a2hBG: -19.97 mg/dl, 95%CI (-30.56, -9.39), p = < 0.0001).
CONCLUSIONS: We demonstrated that Ugandan ART naïve PWH with pre-diabetes at enrollment have consistent improvement in both fasting blood glucose and glucose tolerance over 48 weeks on dolutegravir. Intensified blood glucose monitoring of these patients in the first six months of dolutegravir may be unnecessary.