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Title: Prevention of type 2 diabetes in people living with HIV : understanding risk factors, and investigating the effectiveness and acceptability of a lifestyle intervention
Author: Duncan, Alastair David
ISNI:       0000 0004 5994 5869
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2016
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People living with HIV have up to a fourfold probability of developing type 2 diabetes (T2D), driven by HIV-related factors including the direct effect of certain HIV medicines, and general factors, notably obesity and age. This mixed-methods research, studying HIV patients in South London, aimed to characterise risk factors for T2D, and investigate the effectiveness and acceptability of a pilot lifestyle intervention. Data from a cross-sectional study (n=338) showed a T2D prevalence of 15.1%. Rather than HIV-specific factors the greater contribution to risk of prediabetes/T2D were the conventional risk factors hepatic steatosis and hypertension (odds ratios 7.3 and 2.6 respectively); modifiable factors made a greater contribution to prediabetes/T2D than fixed or historic factors. A pilot diet and activity intervention for people with HIV and prediabetes (n=33) demonstrated statistically significant improvements in 6-month change in glucose and insulin for both fasting levels (5.5% and 23.6% reductions respectively) and postprandial 3-hour incremental area under the curve (17.6% and 31.4% reductions respectively), and significant reductions in mean values for weight (4.7%), waist (6.2%), systolic blood pressure (7.7%) and fasting triglycerides (36.2%). Qualitative interviews (n=23) identified key themes of confidentiality and fear of disclosure of HIV status. Those who declined participation or achieved fewer intervention goals exhibited an external health locus of control, blaming diabetes risk on HIV medicines. Those who achieved more goals prioritised treating prediabetes. Enablers included a desire to avoid adding to pill or disease burden, and a strong support network. Deliberate weight loss leading to loss of cultural identity and disclosure of HIV status were significant barriers. T2D is highly prevalent in HIV. The effectiveness of the pilot intervention demonstrates the potential to prevent or delay T2D in HIV. However, people living with HIV present with unique barriers to change; future interventions must address these to improve effectiveness.
Supervisor: Peters, Barry Stephen ; Goff, Louise Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available