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Logo of nihpaAbout Author manuscriptsSubmit a manuscriptNIH Public Access; Author Manuscript; Accepted for publication in peer reviewed journal;
 
Antivir Ther. Author manuscript; available in PMC Jan 1, 2011.
Published in final edited form as:
Antivir Ther. 2010; 15(4): 571–577.
doi:  10.3851/IMP1557
PMCID: PMC2943237
NIHMSID: NIHMS220807
Glycated Hemoglobin in Diabetic Women with and Without HIV Infection: Data from the Women's Interagency HIV Study
Marshall J. Glesby,1 Donald R. Hoover,2 Qiuhu Shi,3 Ann Danoff,4 Andrea Howard,5 Phyllis Tien,6 Dan Merenstein,7 Mardge Cohen,8 Elizabeth Golub,9 Jack DeHovitz,10 Marek Nowicki,11 and Kathryn Anastos12
1Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, NY
2Department of Statistics and Biostatistics, Rutgers University, Piscataway, NJ
3School of Health Sciences and Practice, New York Medical College, Valhalla, NY
4Department of Medicine, New York University School of Medicine, New York, NY
5Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
6Department of Medicine, University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, San Francisco, CA
7Department of Medicine, Georgetown University Medical Center, Washington, DC
8Departments of Medicine, Stroger (Cook County) Hospital and Rush Medical College, Chicago, IL
9Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
10State University of New York Health Science Center at Brooklyn, Brooklyn, NY
11Department of Medicine, University of Southern California, Los Angeles, CA
12Department of Medicine, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY
Corresponding author: Dr. Marshall J. Glesby, Weill Cornell Medical College, 525 East 68th St., Box 566, New York, NY 10075, Phone: 212-746-7134, Fax: 212-746-8852, mag2005/at/med.cornell.edu
Abstract
Background
Limited data suggest that glycated hemoglobin (hemoglobin A1c; A1C) values may not reflect glycemic control accurately in HIV-infected individuals with diabetes.
Methods
We evaluated repeated measures of paired fasting glucose and A1C values in 315 HIV-infected and 109 HIV-uninfected diabetic participants in the Women's Interagency HIV Study. Generalized estimating equations used log A1C as the outcome variable, with adjustment for log fasting glucose concentration in all models.
Results
An HIV-infected woman on average had 0.9868 times as much A1C (that is, 1.32% lower; 95% confidence interval 0.9734-0.9904) as an HIV-uninfected woman with the same log fasting glucose concentration. In multivariate analysis, HIV serostatus was not associated, but white, other non-black race, and higher red blood cell mean corpuscular volume (MCV) were statistically associated with lower A1C values. Use of diabetic medication was associated with higher A1C values. In multivariate analysis restricted to HIV-infected women, white and other race, higher MCV, and HCV viremia were associated with lower A1C values whereas older age, use of diabetic medications and higher CD4 cell count were associated with higher A1C values. Use of combination antiretroviral therapy, protease inhibitors, zidovudine, stavudine, or abacavir was not associated with A1C values.
Conclusions
We conclude that A1C values were modestly lower in HIV-infected diabetic women relative to HIV-uninfected diabetic women after adjustment for fasting glucose concentration. The difference was abrogated by adjustment for MCV, race, and diabetic medication use. Our data suggest that in clinical practice A1C gives a reasonably accurate refection of glycemic control in HIV-infected diabetic women.