SEVERE HYPERGLYCEMIA IN AN HIV CLINIC - PREEXISTING VERSUS DRUG-ASSOCIATED DIABETES-MELLITUS

We determined the frequency and clinical nature of severe hyperglycemi a in a university clinic for HIV-l-infected patients. The medical reco rds of 1392 adult HN-infected patients were reviewed for cases of seve re hyperglycemia, defined as two or more serum glucose values >250 mg/ dl or diabetes treatment during clinic care. Demographic information, family histories of diabetes mellitus, body weights, CD4(+) lymphocyte counts, and use of corticosteroids, megestrol acetate, pentamidine, o r didanosine were recorded for subjects meeting the case definition. C omparisons were made between preexisting diabetic (group 1) and incide nt hyperglycemic cases (group ?). Less than 2% of the total clinic pop ulation experienced severe hyperglycemia: 12 in group 1 and 13 in grou p 2. Group 2 had lower body weights (mean, 70.6 kg versus 90.0 kg; p < 0.05) and more advanced HIV disease (mean CD4 count, 79/mm(3) versus 550/mm(3); p < 0.05) than group 1. Group 2 cases had evidence of drug- associated hyperglycemia; four cases demonstrated hyperglycemia coinci ding with large fluctuations in weight during megestrol therapy. Among megestrol recipients, cases did not differ from noncases in demograph ics, weight, or CD4 count. Severe hyperglycemia is uncommon in adult H IV-infected patients. Approximately one half of these patients have pr eexisting diabetic conditions; many of the remainder may have drug-ind uced hyperglycemia, especially as a result of corticosteroids or meges trol acetate.