Diet and exercise reduce the risk of developing diabetes in people with HIV

Individual dietary recommendations can lead to a clinically and statistically significant reduction in glucose, weight and other risk factors for diabetes in people living with HIV, follows from the results of a small study in the UK.

“There are serious barriers to changing the lifestyle of people living with HIV, including stigma and isolation problems that need to be considered when developing diabetes prevention measures,” commented Alastair Duncan from Guy and St. Thomas Hospital in London.

Studying the impact of an integrated approach has provided qualitative data on factors that motivate people to change their lifestyle or think about it.

Previous studies of behavioral correction in people living with HIV have mainly focused on the risk of developing cardiovascular disease and have not addressed the likelihood of diabetes.

Assessment of comprehensive measures to influence the behavior of PLHIV included 6 visits to a nutritionist per month, during which the doctor gave individual recommendations on how to make changes in the patient’s lifestyle. The proposed procedure was carried out in order to achieve moderate weight loss by limiting the energy received by the body and increasing physical activity, along with reducing the influx of saturated fats, sugar and salt, as well as increasing the consumption of fruits, vegetables and whole grains. All measures used in working with PLHIV have previously been shown to be highly effective in two independent studies of diabetes prevention in the general population.

Monthly tasks to achieve the objectives of the study were agreed in advance during meetings of the nutritionist and participants. The specialist used methods of motivational interviewing and cognitive-behavioral therapy, including setting goals and self-control. The tasks of each were individual: for example, nutritional recommendations were adapted to the ethnicity and habits of the patient, socio-economic status, lifestyle, accessibility of food, as well as the ability to prepare meals and medical indications.

The experiment involved twenty-eight people living with HIV. A specific fasting blood glucose level (6.0–6.9 mmol / L) was used as the main criterion for inclusion in the study, indicating that the patient is in the so-called “prediabetes” group.

The average age of the volunteers was 54 years; three quarters of them were men. There was ethnic diversity in the group.

At the beginning of the study, the average body mass index of patients was 30.5 (levels above 30 indicate obesity), 57% had hypertension, 79% had metabolic syndrome, 61% had liver steatosis, and 4% had cardiovascular disease.

Participants took antiretroviral drugs for an average of ten years, and slightly less than half of them had previously been on therapy that could increase their risk of developing diabetes (zidovudine, stavudine, didanosine, indinavir, lopinavir).

Of the ten goals proposed to participants, they reached an average of five. The most often achieved were a decrease in sodium intake to <2.5 g per day (82%) and a reduction in sugar intake to <25 g per day (61%). Also, 57% of participants increased their activity to 10,000 steps per day, and as much as limited to <10% of total energy consumption, getting saturated fats with food.

However, only 22% of the participants managed to achieve a weight loss of 7%, and 14% managed to increase the consumption of monounsaturated fats to> 15% of the total energy consumption.

Comparing the results at the beginning and at the end of the six-month course, experts noted that the program significantly reduced:

• fasting glucose (by 7.9%, from 6.3 to 5.8 mmol / l)
• additional glucose area under the curve in the food tolerance test (decrease of 17.6%, from 255 to 210 mmol / l per min)
• fasting insulin (decrease by 22.7%, from 100.1 to 77.1 pmol / l)
• incremental insulin area under the curve in the food tolerance test (decrease by 31.4%, from 1870 to 1283 pmol / l x min)
• weight (decrease by 4.6%, from 88.8 to 84.7 kg)
• waist circumference (by 6.2%, from 107.1 to 100.5 cm)
• systolic blood pressure (decrease by 7.4%, from 135 to 125 mmHg)
• triglycerides (decrease of 36.7%, from 2.07 to 1.31 mmol / l)

According to the results of the study, scientists noted that the results of the decrease in indicators were an order of magnitude higher than those that are usually demonstrated with the participation of HIV-negative people. So, in general population studies, such changes are associated with a 29% decrease in the incidence of diabetes.

“We have demonstrated the positive effects of lifestyle correction measures to reduce the risk of type 2 diabetes associated with HIV. Future interventions should be aimed at further reducing individual barriers to the achievement of a successful outcome in this group”.