Diabetes, Metabolic Syndrome and Obesity (Jan 2021)
Metabolic Control and Determinants Among HIV-Infected Type 2 Diabetes Mellitus Patients Attending a Tertiary Clinic in Botswana
Abstract
Godfrey Mutashambara Rwegerera,1,2 Dorothea HP Shailemo,3 Yordanka Pina Rivera,4 Kathryn O Mokgosi,5 Portia Bale,6 Taibat Aderonke Oyewo,2,7 Bruno Diaz Luis,2 Dereje Habte,8 Brian Godman9– 11 1Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana; 2Department of Medicine, Princess Marina Hospital, Gaborone, Botswana; 3Department of Pharmacology and Therapeutics, School of Pharmacy, University of Namibia, Windhoek, Namibia; 4Department of Medicine, Sidilega Private Hospital, Gaborone, Botswana; 5Department of Obstetrics and Gynaecology, Nyangabgwe Referral Hospital, Francistown, Botswana; 6Otse Outpatient Clinic, District Health Management Team, Lobatse, Botswana; 7Department of Family Medicine, University of Botswana, Gaborone, Botswana; 8Consultant Public Health Specialist, Addis Ababa, Ethiopia; 9School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa; 10Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK; 11Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, SwedenCorrespondence: Godfrey Mutashambara RwegereraDepartment of Internal Medicine, Faculty of Medicine, University of Botswana, Corner of Notwane and Mobuto Road, Plot 4775, Gaborone, BotswanaTel +26775753207Email [email protected]: We primarily aimed at determining the prevalence of metabolic syndrome and abnormal individual metabolic control variables in HIV-infected participants as compared to HIV-uninfected participants given current concerns. Our secondary objective was to determine the predictors of metabolic syndrome and individual metabolic control variables among the study participants to guide future management.Patients and Methods: A descriptive, case-matched cross-sectional study for four months from 15th June 2019 to 15th October 2019 at Block 6 Diabetes Reference Clinic in Gaborone, Botswana. We compared the proportions of metabolic syndrome and individual metabolic control variables based on gender and HIV status by means of bivariate analysis (Chi-squared test or Fisher’s exact test) to determine factors associated with metabolic control. A p-value of less than 0.05 was considered statistically significant.Results: Overall, 86% of the study participants were found to have metabolic syndrome by International Diabetes Federation (IDF) criteria with 79.8% among HIV-infected and 89.1% among HIV-negative participants (p-value = 0.018). Older age was significantly associated with metabolic syndrome (p-value = 0.008). Female gender was significantly associated with metabolic syndrome as compared to male gender (P-value < 0.001), and with a statistically significant higher proportion of low HDL-C compared to males (P-value < 0.001). Female participants were significantly more likely to be obese as compared to males (P-value < 0.001). High triglycerides were more common in HIV-infected compared to HIV-negative participants (P-value = 0.004). HIV-negative participants were more likely to be obese as compared to HIV-infected participants (P-value = 0.003).Conclusion: Metabolic syndrome is an appreciable problem in this tertiary clinic in Botswana for both HIV-infected and HIV-negative participants. Future prospective studies are warranted in our setting and similar sub-Saharan settings to enhance understanding of the role played by HAART in causing the metabolic syndrome, and the implications for future patient management.Keywords: human immunodeficiency virus infection, HIV, diabetes mellitus, metabolic syndrome, sub-Saharan Africa, Botswana
