Individual-Level and Clinic-Level Factors Associated With Achieving Glycemic Control in a Large Cohort of People With HIV in Care-Washington, DC.
Individual-Level and Clinic-Level Factors Associated With Achieving Glycemic Control in a Large Cohort of People With HIV in Care-Washington, DC.
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DOI：
10.1097/qai.0000000000002416
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发表时间：
2020-09-01
期刊：
影响因子：
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通讯作者：
DC Cohort Executive Committee
中科院分区：
文献类型：
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作者：
Happ LP;Monroe AK;Young HA;Ma Y;Greenberg AE;Horberg MA;Castel AD;DC Cohort Executive Committee
对包括糖尿病(DM)在内的非传染性疾病的优化管理至关重要，因为艾滋病毒携带者(PWH)接受抗逆转录病毒治疗的寿命更长。我们的目标是评估患者水平和临床水平的因素与达到7.0%的糖化血红蛋白(HbA1c)≤在慢性重型肝炎和糖尿病。DC Cohort是PWH的观察性临床队列，从2011年到2019年在华盛顿特区的12个地点进行了跟踪调查。在确诊为糖尿病和糖化血红蛋白升高的慢性重型肝炎患者中，我们研究了达到糖化血红蛋白≤7.0%与人口统计和临床因素之间的关系，包括及时更新的药物数据，以及与服务和结构相关的临床水平因素。建立多水平边际扩展COX回归模型，找出与糖化血红蛋白≤7.0%相关的因素。419名受试者中，超过一半(52.3%)的人HbA1c≤为7.0%。与HbA1c≤7.0%相关的个体水平因素包括在登记后被诊断为糖尿病和自被诊断为艾滋病毒以来的较长时间[风险比(HR)=2.65和1.13，P<；0.05]。向内分泌科医生就诊与预后相关[调整后的心率(AHR)=1.41 95%可信区间(CI)：(1.01~1.97)]。此外，比较治疗每个人的诊所、推荐每个人的诊所或混合治疗和推荐的诊所显示，与混合治疗的诊所相比，去治疗每个人的诊所[AHR=1.52 95%CI：(1.21至1.90)]或推荐每个人的诊所[AHR=2.24 95%CI：(1.63至3.07)]之间存在关联。在PWH的城市队列中，实现血糖控制的因素有多种。确定特定的服务或结构是否改善糖尿病结局可能会改善PWH和DM的健康结局。
Optimal management of noncommunicable diseases, including diabetes mellitus (DM), is crucially important as people with HIV (PWH) live longer with antiretroviral therapy. Our objective was to assess patient-level and clinic-level factors associated with achieving hemoglobin A1c (HbA1c) ≤7.0% among PWH and DM. The DC Cohort, an observational clinical cohort of PWH, followed from 2011 to 2019 at 12 sites in Washington, DC. Among PWH with diagnosed DM and elevated HbA1c (>7.0%), we examined the association between achieving HbA1c ≤7.0% and demographic and clinical factors, including time-updated medication data, and clinic-level factors related to services and structure. A multilevel marginal extended Cox regression model was generated to identify factors associated with time to HbA1c ≤7.0%. Over half (52.3%) of 419 participants achieved HbA1c ≤7.0%. Individual-level factors associated with HbA1c ≤7.0% included a diagnosis of DM after enrollment and a longer time since HIV diagnosis [hazard ratio (HR) = 2.65 and 1.13, P < 0.05 for both]. Attending a clinic with an endocrinologist was associated with the outcome [adjusted HR (aHR) = 1.41 95% confidence interval (CI): (1.01 to 1.97)]. In addition, comparing clinics that treat everyone, refer everyone or have a mix of treating and referring, showed an association between attending a clinic that treats everyone [aHR = 1.52 95% CI: (1.21 to 1.90)] or a clinic that refers everyone [aHR = 2.24 95% CI: (1.63 to 3.07)] compared with clinics with a mix in achieving glycemic control. Multiple factors are associated with achieving glycemic control in an urban cohort of PWH. Determining if specific services or structures improve DM outcomes may improve health outcomes for PWH and DM.