Background: Metabolic complications have been associated with HIV infection and treatment.  This study examines incidence rates of DM in HIV-infected individuals and compares these rates to non-infected individuals enrolled in California Medicaid (Medi-Cal).

Methods: Medi-Cal claims from July 1994 to June 2000 were examined for DM incidence rates in men and women over age 18 with and without HIV diagnoses.  Individuals were defined as having HIV if a claim used ICD-9 codes 042-HIV infection, V08-asymptomatic HIV infection, or 795.71-non-specific serologic evidence of HIV.  An HIV diagnosis served as the index date.  To assess only individuals with new HIV diagnoses, patients had to be free of HIV-related claims and antiretroviral pharmacy claims for 1 year prior to inclusion.  DM was identified if a claim used ICD-9 codes 250.0 through 250.9 (Type 1 and Type 2) or had a pharmacy claim for anti-diabetic medication. In order to assess incident cases of DM, subjects had to be free of diabetes-related diagnoses and anti-diabetic pharmacy claims for 1 year prior to inclusion. Incidence rates of DM per person-year were determined via log-linear regression.

Results: A total of 7219 (61% male) individuals with HIV and 2,792,971 (30% male) individuals without HIV were studied yielding a total of 7,101,180 person-years.  Age-specific DM incidence rates for HIV infected and non-infected men and women are listed below.

Age Groups		Men	95% CI	Women	95% CI
HIV+	18-24	0.0604	0.0394,0.0927	0.0607	0.0447,0.0825
	25-34	0.1091	0.0959,0.1241	0.0922	0.0788,0.1078
	35-44	0.1110	0.1007,0.1223	0.1060	0.0924,0.1216
	45-54	0.1090	0.0942,0.1262	0.1388	0.1145,0.1682
	55-65	0.1304	0.1030,0.1651	0.1501	0.1109,0.2030
	65+	0.1228	0.0854,0.1768	0.0952	0.0632,0.1432
MediCal	18-24	0.0078	0.0074,0.0082	0.0083	0.0081,0.0085
	25-34	0.0141	0.0137,0.0144	0.0134	0.0132,0.0137
	35-44	0.0226	0.0222,0.0231	0.0232	0.0229,0.0236
	45-54	0.0366	0.0359,0.0373	0.0462	0.0456,0.0469
	55-65	0.0518	0.0509,0.0528	0.0585	0.0576,0.0593
	65+	0.0431	0.0426,0.0436	0.0440	0.0436, 0.0444

Age-specific relative risk for DM in individuals with HIV compared to those without HIV range from 7.74 (95% CI: 5.03, 11.91, p<0.001) in individuals age 18-24 to 2.16 (95% CI: 1.44, 3.25, p< 0.001) in individuals age 65+. 

Conclusion: These data suggest an association between increased incidence of DM in HIV-infected individuals compared to non-infected individuals.