Metabolic Control and Determinants Among HIV-Infected Type 2 Diabetes Mellitus Patients Attending a Tertiary Clinic in Botswana

Godfrey Mutashambara Rwegerera; Dorothea H P Shailemo; Yordanka Pina Rivera; Kathryn O Mokgosi; Portia Bale; Taibat Aderonke Oyewo; Bruno Diaz Luis; Dereje Habte; Brian Godman

doi:10.2147/DMSO.S285720

Metabolic Control and Determinants Among HIV-Infected Type 2 Diabetes Mellitus Patients Attending a Tertiary Clinic in Botswana

Diabetes Metab Syndr Obes. 2021 Jan 11:14:85-97. doi: 10.2147/DMSO.S285720. eCollection 2021.

Authors

Affiliations

¹ Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
² Department of Medicine, Princess Marina Hospital, Gaborone, Botswana.
³ Department of Pharmacology and Therapeutics, School of Pharmacy, University of Namibia, Windhoek, Namibia.
⁴ Department of Medicine, Sidilega Private Hospital, Gaborone, Botswana.
⁵ Department of Obstetrics and Gynaecology, Nyangabgwe Referral Hospital, Francistown, Botswana.
⁶ Otse Outpatient Clinic, District Health Management Team, Lobatse, Botswana.
⁷ Department of Family Medicine, University of Botswana, Gaborone, Botswana.
⁸ Consultant Public Health Specialist, Addis Ababa, Ethiopia.
⁹ School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa.
¹⁰ Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK.
¹¹ Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden.

Abstract

Purpose: 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: Botswana; HIV; diabetes mellitus; human immunodeficiency virus infection; metabolic syndrome; sub-Saharan Africa.

Grants and funding

The study was funded by Office of Research and Development (ORD) of the University of Botswana (Grant Project Number: R1210).