Mathis, Taylor
(2024)
A Descriptive Population Analysis of the Incidence, Prevalence, and Case Definition Comparison of Type II Diabetes Mellitus in the U.S. Military HIV Natural History Study.
Master Essay, University of Pittsburgh.
Abstract
The Human immunodeficiency virus (HIV) attacks the body’s immune cells, putting people living with HIV (PWH), at an increased risk of developing type II diabetes (T2DM). The aims of this study are 1) Describe the incidence and prevalence of diabetes mellitus, its treatment, complications, and its correlates in the U.S. Military HIV Natural History Study (NHS) cohort from 2009-2019, and 2) Identify case definitions and clinical criteria of diabetes mellitus using combinations of different data elements based on data source. We analyzed data from the NHS, including participants enrolled from 2009–2019. T2DM was defined using the NHS diagnosis code and two alternative definitions: (1) ≥2 diabetes-related ICD codes >30 days apart, and (2) laboratory criteria (fasting glucose ≥126 mg/dL, hemoglobin A1c ≥6.5%). Annual diabetes prevalence and incidence were calculated, and Kaplan-Meier survival analysis estimated time to diagnosis. Concordance among diagnostic methods was assessed using intersection analyses and confusion matrices. Among 2726 participants, 296 (10.9%) were diagnosed with diabetes. The prevalence of T2DM over the study period was 10.9% with an incidence of 5.78% during the observation period, and a crude incidence rate of 7.1 cases per 1,000 person-years. Among active-duty members, the cumulative incidence was 2.72%, with a crude incidence rate of 3.2 cases per 1,000 person-years. When comparing diagnostic criteria, ICD codes had the highest sensitivity (85.8%) relative to the NHS reference standard, while A1C and fasting blood glucose exhibited higher specificities (97.8%). Overall, ICD codes demonstrated strong accuracy (95.3%), aligning closely with the NHS criteria. T2DM was significantly more common among PWH in the Military Health System, with rates approximately four times higher than the general military population. The public health significance of these findings is the importance of using robust diagnostic criteria, such as NHS and ICD codes, to accurately identify diabetes among PWH in the military. Improved screening and monitoring protocols based on these findings could enhance early diabetes detection and intervention, ultimately reducing complications and improving public health outcomes for military beneficiaries.
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Details
| Item Type: |
Other Thesis, Dissertation, or Long Paper
(Master Essay)
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| Contributors: |
| Contribution | Contributors Name | Email | Pitt Username | ORCID  |
|---|
| Committee Chair | Glynn, Nancy W | epidnwg@pitt.edu | epidnwg | UNSPECIFIED | | Committee Member | Buchanich, Jeanine | jeanine@pitt.edu | jeanine | UNSPECIFIED | | Committee Member | Agan, Brian | bagan@idcrp.org | UNSPECIFIED | UNSPECIFIED |
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| Date: |
19 December 2024 |
| Date Type: |
Completion |
| Access Restriction: |
No restriction; Release the ETD for access worldwide immediately. |
| Number of Pages: |
43 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Public Health > Epidemiology |
| Degree: |
MPH - Master of Public Health |
| Thesis Type: |
Master Essay |
| Refereed: |
Yes |
| Date Deposited: |
19 Dec 2024 19:54 |
| Last Modified: |
19 Dec 2024 19:54 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/47255 |
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