Diabetes Care Misses Mark in HIV Patients

By Ed Susman, Contributing Writer, MedPage Today

Published: October 25, 2010

Reviewed by Barry S. Zingman, MD;

Professor of Clinical Medicine,

Albert Einstein College of Medicine, Bronx, NY.

VANCOUVER -- The gaps in diabetes care among patients diagnosed with human immunodeficiency virus infection are wide enough to drive trucks through, researchers said here at the annual meeting of the Infectious Diseases Society of America.

In scrutinizing how well different types of doctors did in providing routine care, researchers found that only doctors at a Canadian endocrinology clinic came anywhere near meeting treatment benchmarks.

For example, when it came to foot examinations -- a key part of diabetes surveillance -- the check was done less than 20% of the time at a Toronto immunodeficiency clinic and an American HIV clinic; about 35% of the time at an American primary care clinic; about 65% of the time at an American endocrinology clinic, and about 90% of the time at the Canadian endocrinology clinic.

"We think that an 80% benchmark is reasonable to achieve in these patients who have both diabetes and HIV infection," said Pascal Bastien, MD, a resident in internal medicine in the University Health Network at the University of Toronto, at his poster presentation.
In none of the various clinics did 80% of the HIV patients achieve target blood pressure, although about 75% of the patients at the Canadian endocrinology clinic achieved that level.
Similarly, Bastien told MedPage Today that all the clinics failed to meet benchmarks for HbA1c goals, for low density lipoprotein cholesterol goals, and even for aspirin therapy.
The researchers followed 50 patients and assessed their medical treatments in a retrospective chart review.

"Documentation of vascular disease and risk factor screening in our clinic did not meet population benchmarks and requires significant improvement," Bastien said. "Guideline-recommended therapies were not optimized, even in our high-risk population."
He considered that doctors treating HIV disease may be so focused on making sure that their patients' HIV infection is under control that they allow other health issues to slide. He noted that concerns about the overall health of HIV patients may still suffer from the years when HIV infection was rapidly fatal.

"Part of the problem may be that the physician is rushed and looks at HIV control as the primary problem for these patients," Joel Ernst, MD, professor of medicine at New York University Langone Medical Center, told MedPage Today.
He also suggested that some of the physicians may be assuming that other primary care doctors are looking after the patients' other medical needs while they concentrate on control of HIV infection.

"Gaps in diabetes care are widespread in both HIV and non-HIV populations," Bastien said, "despite literature documenting that benchmarks are achievable."
He suggested that to overcome the wide gaps in therapy identified in his study, a multifaceted quality improvement intervention might be required, including the determination of which of a patient's clinicians should be primarily responsible for diabetes care.
Bastien and Ernst had no disclosures.
Primary source: Infectious Diseases Society of America