Burden of Type 2 Diabetes Mellitus and associated factors among HIV negative and positive patients in two regional referral hospitals in the Manzini Region, Eswatini

Background: Type 2 diabetes mellitus is an emerging non-communicable disease in low and middle-income countries in sub-Saharan Africa Since the rollout of antiretroviral therapy in Eswatini, the burden of diabetes in human immunodeficiency virus infected people and comparison against HIV negative control population has not been evaluated in Eswatini. Aim: This study aimed at assessing proximal and distal predictors of diabetes among HIV positive adults in comparison to HIV negative adults. Material and Methods. We employed a cross-sectional study design with 498 subjects selected at random in each group. Face-to-face interviews were conducted to obtain socio-demographic and risk factors. Venous blood was collected, fasting blood glucose and 2-hour oral glucose tolerance test. Multivariable logistic regression was used to identify significant determinants of diabetes. Results and Discussion. Prevalence of diabetes was 25.6% (95%CI: 22.6 – 28.2). A higher (36.1%; 95%CI: 31.9 – 40.4) prevalence of diabetes was observed in the HIV positive cohort compared to the HIV negative group (14.8%; 95%CI: 11.6 – 17.5). Being ≥40 years posed a higher risk (OR=1.04; 95%CI: 1.00 – 1.07, p=0.04) of developing T2DM compared to those <40 years. Overweight (OR=1.82; 95%CI: 1.06 – 3.10, p=0.029) and obesity (OR=3.73; 95%CI: 2.26 – 6.14, p<0.001) increased the risk of diabetes. Alcohol intake increased the risk of diabetes 15 folds (OR=15.05; 95%CI: 9.03 – 25.11, p<0.001) compared to not taking alcohol. Moderate (OR=0.4; 95%CI: 0.25 – 0.67, p<0.001) and vigorous physical activity (OR=0.1; 95%CI: 0.05 – 0.14, p<0.001) reduced the risk of diabetes. Being HIV positive increased the risk of T2DM (OR=3.43; 95%CI: 2.28 – 5.14; p<0.001) compared to being HIV negative. Conclusions. HIV positive cohort had a higher prevalence of Type 2 diabetes mellitus and being HIV positive is a risk factor for diabetes; hence HIV care services need to include diabetes prevention and management