Diabetes mellitus

Clinical description

• Unmanaged diabetes causes long-term damage to large and small blood vessels.
• It may lead to blindness, lower limb amputations, nerve damage, renal failure, heart attack and

stroke.

• Insulin resistance can be caused by HIV infection and ARVs, particularly DTG, ATV/r, LPV/r and

DRV.

Screening and Diagnosis

• Screen all of the following patient groups for diabetes using a random (non-fasting) blood glucose

test. Screen at ART initiation and every 12 months thereafter.

o Age 40 years + o Age under 40 years with any of the following risk factors:

• Family history of diabetes
• Hypertension
• Dyslipidaemia (i.e., High triglycerides, high total cholesterol and low high- density-

lipoprotein cholesterol)

• Obesity (BMI > 30)
• Normal random blood sugar (RBS): below 200mg/dl (<11 mmol/L)

o If patient is asymptomatic, repeat after 12 months o If patient is symptomatic (e.g., weight loss, polyuria, polydipsia), conduct fasting blood sugar (FBS) as soon as possible.

• Elevated RBS: 200mg/dl and above (>11 mmol/L)

o Conduct FBS

• Elevated FBS: 126mg/dl and above (>7mmol/L):

o Advise lifestyle modifications o Start DM treatment as per latest Malawi Standard Treatment Guidelines

• Start Metformin at a low dose and increase gradually. Maximum dose for patients on

DTG is 1000mg/day o Additionally, do the following:

• Reinforce lifestyle interventions at every clinic visit
• Educate HIV patients on metformin about the symptoms of lactic acidosis, including

fatigue, weight loss, nausea, abdominal pain, dyspnea, and arrhythmia.