Lifestyle determinants of diabetes mellitus amongst people living with HIV in the Eastern Cape province, South Africa

Digital continuous glucose monitoring systems for patients with HIV-diabetes comorbidity in Ethiopia: a situational analysis

In patients with HIV-diabetes mellitus (DM) comorbidity, invasive blood glucose testing can increase the risk of HIV-related blood contamination and discourage regular glucose monitoring. Digital continuous glucose monitoring (CGM) systems may allow real-time glucose monitoring without the need for blood specimens. However, in high-burden HIV-DM countries, current glucose monitoring practices and their challenges are insufficiently explored to guide digital CGM research and developments. This study sought to explore the lived experiences of patients with HIV-DM comorbidity and their healthcare providers regarding glucose monitoring practices, and their openness to CGM and other digital technologies, to provide formative insights for a planned implementation trial of digital CGM in Ethiopia. A phenomenological qualitative study was conducted among patients with HIV-DM and their providers at the two largest public hospitals in Ethiopia. Both groups were interviewed face-to-face about DM clinic workflows, blood glucose monitoring and self-testing practices, and potential benefits and limitations of digital CGM systems. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. A total of 37 participants were interviewed, consisting of 18 patients with HIV-DM comorbidity and 19 healthcare providers. Patients had an average (min-max) duration of living with HIV and DM of 14 (8-31) and 6.6 (1-16) years, respectively, with 61% taking insulin-33% alone and 28% alongside oral hypoglycemic agents-and 79% having comorbid hypertension. The thematic analysis identified five main themes: "Diabetes routine clinical care and follow-up", "Blood glucose monitoring practices", "Perceptions about digital CGMs", "Technology adoption", and "Financial coverage". Home self-testing was deemed beneficial, but the need for regular follow-ups, result cross-referencing, and glucometer reliability were emphasized. Patients performed fingerstick themselves or with family members, expressing concerns about waste disposal and the risk of HIV transmission. They rely mainly on health insurance for DM care. Patients and providers are happy with the quality of DM services but note a lack of integrated HIV-DM care. Very few providers and patients possessed background information about digital CGMs, and all have not yet utilized them in practice, but expressed keen interest in trying them, representing an important step for upcoming CGM clinical trials in these settings. Given the crucial role of regular glucose testing in managing HIV-DM comorbidity, it is essential to explore testing options that align with patient preferences and minimize the risk of HIV transmission.

Interventions for Type 2 Diabetes reduction among older people living with HIV in Harare

BACKGROUND

Interventions for Type 2 Diabetes reduction among older people aged more than 50 years living with HIV (PLWH) are pertinent as they face excess risks amid a growing population of ageing PLWH.

AIM

To describe interventions for Type 2 Diabetes reduction among older people living with HIV in Harare Urban DistrictSetting: The study was conducted in a low socio-economic setting from five primary health care clinics in Harare urban District.

METHODS

A qualitative multi-method approach was applied using an exploratory descriptive design and an integrative review literature. The exploratory descriptive study collected data from two purposively selected samples; (1) older PLWH and (2) nurses. Whittemore and Knafl's framework was used for the integrative literature review with articles from 2013 to 2023 selected. Data source triangulation was applied using Braun and Clark's content analysis framework. Ethical approval was obtained (14056739_CREC_CHS_2022).

RESULTS

23 older PLWH with mean age, 62 years, 9 nurses with an average of 6 years' experience and 12 articles comprised the three data sources.  Key themes that emerged were that, screening should include; assessment from a younger age; assessment of HIV and ART-specific risks; diagnostic testing of Type 2 diabetes tests at ART initiation and routinely. Health education should provide information on adequate physical activity parameters and increased consumption of fruits and vegetables. Metformin may be considered as a pharmacological intervention where lifestyle interventions fail.

CONCLUSION

The proposed interventions suggest measures to reduce Type 2 Diabetes and mitigate excess risks faced by older PLWH.Contribution: Improved screening, health education and pharmacological interventions for older PLWH in primary health care settings enable Type 2 Diabetes reduction.

Lifestyle in People Living With HIV: A Study of Patients in Kermanshah, Iran

There is limited research on the role of lifestyle in people living with HIV (PLWH). This study investigated the health-promoting lifestyle among PLWH in Kermanshah-Iran. This cross-sectional study was conducted in 321 PLWH patients referred to the Kermanshah Behavioral Diseases counseling Center between 2017 and 2018. Patients were selected using the convenience sampling method. Data was collected using a standard health promotion lifestyle profile (HPLP-II) questionnaire. Regression and T-tests were used in SPSS 21 and Stata software to analyze the data. The mean age of patients was 41.07 ± 9.14 years. The mean HPLP score of patients in stress management had the lowest mean score (19.44 ± 4.22), and health responsibility had the highest mean score (22.22 ± 4.57). Comparisons between women and men also showed that women had a lower mean score than men in stress management. In addition, significant differences in their HPLP were observed only in the area of physical activity. The final model had significant influence on the PLWH (P < .001), in which the main predictors were housing status, family members, and feelings of happiness. These variables had a negative effect on HPLP in PLWH's. An appropriate education and training has improved the PLWH health-oriented lifestyle. Given that the housing situation affected health responsibility, nutrition, spiritual growth, interpersonal relationships, and stress management, may have caused severe anxiety and confusion in PLWH. Addiction also had a negative effect on patients' spiritual growth. Relatively simple lifestyle changes such as nutrition and stress management can significantly improve PLWH.