601 - Disparities in Diabetes Care: Smoking Cessation among Women and Minorities Living with HIV at an Urban Academic Medical Center

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Presenting Author(s)

Peter Cangialosi

Medical Student
Rutgers New Jersey Medical School
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

Mark Liotta

Medical Student
Rutgers New Jersey Medical School
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
DF

Diana Finkel

Assistant Professor
Rutgers NJMS
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SS

Shobha Swaminathan

Associate Professor
Rutgers New Jersey Medical School
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SK

Steven Keller

Professor
Rutgers New Jersey Medical School
Newark, New Jersey
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Background: People living with HIV (PLWH) and diabetes mellitus are at increased risk of developing significant medical complications such as atherosclerotic cardiovascular disease. Disproportionate rates of diabetes and HIV among minority groups raise the issue of how demographic disparities may impact care. The American Diabetes Association (ADA) 2020 guidelines for diabetes care recommend optimal glycemic levels (A), blood pressure control (B), lipid reduction (C), and smoking cessation (N), commonly referred to as ABC or ABCN criteria. This quality assessment project examines diabetes management in PLWH by gender, race/ethnicity, and BMI, in a predominantly minority-serving clinic, as assessed by rates of guideline adherence to the above metrics.

Methods: This project was reviewed and approved by the Rutgers IRB. Patients from an HIV registry of University Hospital Infectious Disease Outpatient clinic in Newark, NJ were reviewed for a diagnosis of diabetes and both a clinic visit and an A1c score recorded between 2/1/2019 and 1/31/2020. Achieving glycemic target was defined as HbA1c < 7.5 for patients < 65 and HbA1c < 8 for patients > 65. Target adherence criteria also included a blood pressure average of < 140/90 over this period and an LDL-c of < 100 mg/dL. Non-smoking status includes both former and never smokers.

Results: Of 1035 patients reviewed, a total of 172 met criteria. Adherence rate for achieving goal HbA1c was 61.6% (95% CI 54.2-68.6, n=172). Blood pressure and LDL-c adherence rates were 65.1% (95% CI 57.7-71.8, n=172) and 67.4% (95% CI 60.1-74.0, n=172), respectively. ABC and ABCN rates were 24.4% (95% CI 18.6-31.4, n=172) and 18.6% (95% CI 13.5-25.1, n=172). The overall smoking rate, as well as the rates in the female subgroup, those with BMI 18.5-24.9, and the non-Hispanic black subgroup were significantly higher than the national average (P< 0.05). Table 1: Demographic Data of PLWH and Diabetes

Table 2: Adherence to ABCN Criteria in Diabetes Care by Demographics for PLWH from 2/1/2019 – 1/31/2020

Conclusion: For diabetic PLWH, smoking cessation requires improvement, particularly in female, normal BMI, and non-Hispanic black subgroups. These findings, in addition to a majority overweight patient population, highlight the need for increased education and interventions aimed at nutritional counseling and risk factor mitigation among all patient subgroups.