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October 9, 2002

Insulin Resistance and HIV-Related LipoatrophyInsulin Resistance and HIV-Related Lipoatrophy

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2002;288(14):1716. doi:10.1001/jama.288.14.1716

In Reply: Dr Mikhail suggests that hypertriglyceridemia and hyperinsulinemia at baseline in our study may have been indicative of type 2 diabetes mellitus that was undiagnosed and/or treated. About 6% to 8% of subjects receiving antiretroviral therapy have diabetes with hyperinsulinemia despite normal fasting glucose, but without any consistent association with hypertriglyceridemia.13 We did not perform oral glucose tolerance testing as part of our study, since insulin resistance was not the primary end point, and we were concerned that such time-consuming testing might have hampered patient recruitment. Nevertheless, no subject in the abacavir switch group, and only 1 (2%) subject in the control group, had fasting glucose greater than 110 mg/dL (7 mmol/L) at baseline. No patient was receiving diabetic therapy at baseline. At week 24, 2 subjects in the abacavir group (and 3 control subjects) had a fasting glucose level greater than 110 mg/dL, with no significant intergroup difference at any time point.

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