Risk for incident diabetes is greater in pre-diabetic men with HIV than without HIV.

BACKGROUND Diabetes mellitus (DM) is a major comorbidity in people living with HIV (PWH). Hyperglycemia below diabetic range defines pre-diabetes (pre-DM). We compared the progression from pre-DM to DM in PWH and people without HIV (PWOH). METHODS Fasting glucose (FG) was measured semi-annually in the MACS since 1999. Men with pre-DM (FG between 100-125 mg/dL, confirmed within a year by FG in the pre-DM range or HbA1c between 5.7-6.4%) were included. The first visit with pre-DM was the baseline visit. Incident DM was defined as FG ≥ 126 mg/dL, confirmed at a subsequent visit, or self-reported DM, or use of anti-DM medication. We used binomial transition models to compare the progression from pre-DM to DM by HIV serostatus, adjusted for age, number of previous pre-DM to DM transitions, ethnicity, body mass index (BMI), family history of DM, and hepatitis C virus (HCV) infection. RESULTS Between 1999 and 2019, 1584 men (793 PWH; 791 PWOH) with pre-DM were included. At baseline, PWH were younger (48 vs 51 years, p < 0.01), had lower BMI (26 vs 27), were more frequently non-white (47% vs 30%), and HCV-infected as per last measure (8% vs 4%) than PWOH (all p < 0.01). Over a median 12-year follow-up, 23% of participants developed DM. In adjusted analyses, the risk for incident DM was 40% [95% CI: 0% to 80%] higher among PWH than PWOH (p = 0.04). CONCLUSION Among men with pre-DM, PWH had an increased risk of incident DM adjusted for competing risk factors, warranting the evaluation of DM prevention strategies.