|Insulin Resistance, Asymptomatic Hyperglycemia, DMa
||Several NRTIs (i.e., d4T, ZDV, ddI)
Several PIs (i.e., LPV/r; less often ATV, ATV/r, DRV/r, NFV, TPV/r)
- Weeks to months after beginning therapy; median of 60 days (adult data)
- Asymptomatic fasting hyperglycemia (possibly in the setting of lipodystrophy), metabolic syndrome, or growth delay
- Frank DM (i.e., polyuria, polydipsia, polyphagia, fatigue, hyperglycemia)
ARV Treated Adults and Children:
Impaired Fasting Glucose
Impaired Glucose Tolerance:
- 0.6–4.7 per 100 person-years (2- to 4-fold greater than that for HIV-uninfected adults)
- Rare in HIV-infected children
|Risk factors for Type 2 DM:
- Metabolic syndrome
- Family history of DM
- High BMI
- Lifestyle modification
- Although uncertain, avoiding the use of d4T may reduce risk.
Obtain RPG Levels at:
- Monitor for polydipsia, polyuria, polyphagia, change in body habitus, and acanthosis nigricans.
For RPG ≥140 mg/dL:
- Initiation of ARV therapy, and
- 3–6 months after therapy initiation, and
- Once a year thereafter.
- Obtain FPG performed after 8-hour fast and consider referral to endocrinologist.
|Counsel on lifestyle modification (i.e., low-fat diet, exercise, no smoking).
Change NRTI (e.g., from d4T, ZDV, or ddI to TDF or ABC).
For Either RPG ≥200 mg/dL Plus Symptoms of DM or FPG ≥126 mg/dL:
FPG 100–125 mg/dL:
- Patient meets diagnostic criteria for DM; consult endocrinologist.
FPG <100 mg/dL: Normal FPG, but Does Not Exclude Insulin Resistance:
- Impaired FPG is suggestive of insulin resistance; consult endocrinologist.
- Recheck FPG in 6–12 months.