Impact of Depression and HIV Symptoms on Glycemic Outcomes among Patients with HIV and Type 2 Diabetes: A Clinical Cohort Study

Abstract

Type 2 diabetes (T2DM) and depressive symptoms frequently co-occur among people with HIV (PWH). Depression may impact diabetes management in PWH. This study evaluated the prevalence of concurrent T2DM and depression among PWH and the impact of depression and HIV symptoms on glycemic outcomes (hemoglobin A1c [A1c], blood glucose [BG]) among people with both HIV and T2DM. We conducted a secondary analysis in the CFAR Network of Integrated Clinical Systems, a multisite clinical cohort including a diverse population of PWH in care from July 2005 through July 2023. Linear regression and linear mixed models were used to estimate the association between depression, HIV symptoms, and glycemic outcomes (A1C, BG) at baseline and over time. Of the 18,562 PWH, 2,945 (16%) also had T2DM. PWH with T2DM were older (56 vs. 49 years) and more often non-Hispanic Black and cis-gender men. The prevalence of depression was not significantly different between PWH with or without T2DM (20% vs. 21%) although more PWH with T2DM received antidepressant medications. Among people with both HIV and T2DM, HIV baseline symptoms and depression were not associated with a change in A1c. Increases in time-updated HIV symptom scores were associated with random (non-fasting) BG levels, with each additional HIV symptom resulting in 0.8 mg/dL increase in random BG level (95% CI: 0.04–1.60, p = 0.04). The prevalence of T2DM was higher among PWH than in the general population. Although depression appears to be well managed, other factors impacting glycemic outcomes among people with both HIV and T2DM require further study.