The U.S. diabetes epidemic and its impact on the health of tens of millions of Americans has been thoroughly reported on in recent decades, particularly as it relates to the significant impact of body mass index (BMI) as a risk. Yet little is known of its prevalence in patients with hemophilia (PWH). Less is understood on the potential associated risk factors in PWH, including age, BMI, and viral comorbidities such as positive hepatitis C virus (HCV) status – HCV is especially prevalent in older patients with hemophilia who were exposed to virally contaminated plasma products in the 1970s and 1980s.
A team of researchers recently conducted a retrospective study to shed light on the subject by contrasting risk in clinic vs non-clinic populations. They compared adult PWHs against two control cohorts, the first of which was a random sample drawn from the National Health and Nutrition Examination Surveys (NHANES). Part of the Centers for Disease Control and Prevention, NHANES is a program of survey-based studies to assess the health and nutritional status of adults and children in the U.S. The second cohort was a random sample of patients attending outpatient clinics at the Veterans Affairs Medical Center (VAMC) in San Diego, CA.
The study, published in the journal Haemophilia, represented a cross-sectional analysis, comparing PWH, NHANES and VAMC subjects. This design allowed investigators to not only compare PWH with unaffected and healthy men but also to a group that is followed in a somewhat similar ambulatory setting as PWH.
The PWH data was drawn from deidentified medical records from four North American hemophilia treatment centers (HTCs). The HTC cohort included 691subjects, examined between 2003-2014, while the NHANES data combined several survey cycles between 2003-2016. The VAMC data was culled from patient records from 2009-2015, 107, 801 in all. Investigators focused primarily on BMI, diabetes, race, age, HCV, and HIV status.
An analysis of the data yielded some interesting findings as PWH were actually leaner in comparison, with a proportionally smaller number of obese patients. In all, 24% of the PWH were obese, compared to 31% in the NHANES and 37% for the VAMC group. In addition, 7% of the PWH were diabetic, while the NHANES and the VAMC groups were 11% and 19% respectively.
“In particular, PWH did not show the pattern of pronounced weight gain in their twenties and thirties found in the general population, as illustrated by the BMI curves for NHANES and VAMC subjects. PWH were also at a lower risk of diabetes than the other two cohorts, noted the authors. “However, the lower risk of diabetes in PWH persisted even after controlling for BMI and age, indicating it was not driven by BMI. In other words, if one were to take a PWH and a man of the same age and BMI from each of the other cohorts, then the PWH would be much less likely to be diabetic.”
While aging was associated with varying diabetes risk for each group, risk for PWH was significantly lower than NHANES. That said, positive HCV viral status specifically in older patients of the PWH group was associated with a dramatic increase in risk.
Though the authors acknowledge that the study is not without limitations, the data reported was enough to compel them to recommend targeted diabetes screening at HTCs.
“These findings inform clinical practice since Hemophilia Treatment Centers are the medical home for many PWH. Providers caring for PWH should intensify diabetes screening in patients who are ≥ 60 years old, especially when HCV positive,” concluded the authors.
Citation
Pandey B, Barnes RFW, Sun HL, Jackson S, Kruse-Jarres R, et al. Risk of diabetes in haemophilia patients compared to clinic and non-clinic control cohorts. Haemophilia. 2022 Mar 3. doi: 10.1111/hae.14515. Epub ahead of print. PMID: 35238443.
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