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Diabetes mellitus in HIV-infected patients: fasting glucose, A1c, or oral glucose tolerance test – which method to choose for the diagnosis?

Overview of attention for article published in BMC Infectious Diseases, July 2018
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Title
Diabetes mellitus in HIV-infected patients: fasting glucose, A1c, or oral glucose tolerance test – which method to choose for the diagnosis?
Published in
BMC Infectious Diseases, July 2018
DOI 10.1186/s12879-018-3221-7
Pubmed ID
Authors

Ana Rita Coelho, Flávia Andreia Moreira, Ana Cristina Santos, André Silva-Pinto, António Sarmento, Davide Carvalho, Paula Freitas

Abstract

Antiretroviral therapy dramatically reduced HIV-related morbidity and mortality, prolonging the lifespan of HIV-infected patients. Greater duration of infection and exposure to antiretroviral therapy makes these patients susceptible to traditional cardio-metabolic risk factors and pathologies. The optimal diagnostic protocol for Diabetes Mellitus in these patients is still controversial. Haemoglobin A1c (HbA1c) has been shown to underestimate glycaemia levels and the oral glucose tolerance test (OGTT) has been shown to reveal cases of glucose metabolism disturbances in patients with normal fasting glucose. Thus, this study aimed to determine the prevalence of prediabetes and diabetes in a population of HIV-infected patients undergoing combined antiretroviral therapy, using three different diagnostic methods (fasting glucose, OGTT and HbA1c), to determine the agreement between the different methods and the characteristics associated with each one. This study analyzed 220 HIV-infected patients on antiretroviral therapy. Patient characteristics were collected using a standardized protocol. Disturbances of glucose homeostasis were defined by the ADA 2017 criteria. Patients were characterized according to the presence or absence of clinical lipodystrophy, and distributed into four different categories, according to the presence, or absence of either clinical lipoatrophy, or abdominal prominence. Insulin resistance was assessed by HOMA-IR and QUICKI indexes. Agreement between the diagnostic methods was assessed by Cohen's kappa coefficient. There were no patients diagnosed with diabetes with HbA1c. 5.9% prevalence was obtained when OGTT was used, and 3.2% prevalence when fasting glucose was used. Prediabetes had a prevalence of 14.1% when using HbA1c, 24.1% when using OGTT, and 20% when using fasting glucose. In all three methods, glucose homeostasis disturbances were associated with older age and higher resistance to insulin. Regarding other characteristics, associations varied between the three methods. The agreement between them was fair, or slight. We observed that HbA1c was the method that diagnosed the least amount of cases and that OGTT was the one that diagnosed the most cases. Accordingly, our results indicate that HbA1c underestimated glycaemia levels in this population and that the use of OGTT might allow an earlier diagnosis of glucose homeostasis disturbances, potentially making it possible to avoid severe complications of DM.

Twitter Demographics

The data shown below were collected from the profiles of 3 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 43 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 43 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 11 26%
Student > Postgraduate 6 14%
Student > Bachelor 6 14%
Student > Ph. D. Student 5 12%
Researcher 3 7%
Other 5 12%
Unknown 7 16%
Readers by discipline Count As %
Medicine and Dentistry 15 35%
Nursing and Health Professions 7 16%
Pharmacology, Toxicology and Pharmaceutical Science 3 7%
Agricultural and Biological Sciences 2 5%
Biochemistry, Genetics and Molecular Biology 2 5%
Other 3 7%
Unknown 11 26%

Attention Score in Context

This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 12 February 2020.
All research outputs
#10,078,592
of 16,936,654 outputs
Outputs from BMC Infectious Diseases
#2,794
of 6,043 outputs
Outputs of similar age
#148,611
of 281,271 outputs
Outputs of similar age from BMC Infectious Diseases
#1
of 1 outputs
Altmetric has tracked 16,936,654 research outputs across all sources so far. This one is in the 38th percentile – i.e., 38% of other outputs scored the same or lower than it.
So far Altmetric has tracked 6,043 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 7.5. This one has gotten more attention than average, scoring higher than 50% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 281,271 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 44th percentile – i.e., 44% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them