Disparities in screening, diagnosis, and treatment of diabetes mellitus among people with HIV at a large southeastern academic health center.

BACKGROUND: People with HIV can survive decades on antiretroviral therapy (ART), but an increasing burden of metabolic disease, including diabetes mellitus (DM), threatens these gains. Prior studies found race and sex disparities in HIV treatment outcomes, but data on comorbid conditions remains scarce. We assessed whether disparities by race, sex, body mass index (BMI), and other factors existed in DM screening, incidence, and treatment outcomes in a large HIV care center in the southeastern US. METHODS: We conducted a retrospective analysis of people with HIV enrolled at the Vanderbilt Comprehensive Care Clinic between 2007-2022 on ART without prevalent DM. We assessed factors associated with DM screening by hemoglobin A1c (HbA1c), DM diagnosis, treatment, and achieving HbA1c ≤7.0%. We used modified Poisson regression to estimate adjusted risk ratios (RRs) to achieve the next step of the care continuum. RESULTS: Older, Black, and overweight or obese people with HIV were more likely to be screened (range of RRs = 1.0-1.1, p < 0.05 each) and diagnosed with DM (range of RRs = 1.8-2.8, p < 0.05 each) compared to reference groups, but there was no significant sex difference after adjusting for other factors. Among those screened and diagnosed with DM, there were no differences in initiating treatment or achieving A1c goals by key characteristics in adjusted models. CONCLUSIONS: Older, Black, and overweight/obese people with HIV were more likely to be screened and diagnosed with DM by their HIV care providers. However, age, BMI, and sex did not affect the initiation of DM medications or achieving A1c goals in this cohort.