2250. Metformin for Preventing Diabetes Mellitus in HIV-Infected Patients with Prediabetes: A Randomized Controlled Trial

BACKGROUND: Both HIV and diabetes mellitus (DM) increase the risk for cardiovascular diseases. Prediabetes (PreDM), a condition preceding DM, is commonly observed in HIV-infected patients receiving antiretroviral therapy (ART). Both metformin and lifestyle interventions have been shown to reduce risk of progression to DM in non-HIV-infected population. This study aimed to evaluate the efficacy of metformin for preventing DM in HIV-infected patients. METHODS: An open-label randomized controlled clinical trial was conducted in HIV-infected patients with PreDM. Patients were randomized into two groups: metformin group (received metformin) and control group (not received metformin). Patients in both groups were counseled regarding diet control and lifestyle modification and followed for 6 months. The primary endpoint was the development of DM. Fasting plasma glucose (FPG), 2-hour 75-gm oral glucose tolerance test, HbA1c, computer-based homeostatic model assessment index of β-cell function (HOMA%B) and insulin resistance (HOMA-IR) were analyzed. RESULTS: Seventy-four patients were enrolled, 37 in each group. Mean age was 49.6 years and 68.9% were males. At baseline, mean CD4 cell count was 570 cells/mm(3) and mean body mass index (BMI) was 24.6 kg/M(2). Baseline characteristics including age, sex, BMI, waist-hip (W/H) ratio, duration of ART, ART regimen, CD4 cell count and HIV RNA were similar between two groups (P > 0.05). Mean FPG, 2hPG, HbA1c, HOMA%B and HOMA-IR at baseline were also similar between two groups (P > 0.05). At 6 months, one patient in metformin group and two in control group developed DM [risk reduction 2.70%; 95% CI, −9.09% to +15.20%]. Mean HbA1c significantly decreased from baseline only in metformin group. HOMA-IR at 6 months was significantly lower in metformin group (1.086 vs. 1.478, P = 0.042). However, BMI, W/H ratio, FPG, 2hPG, HbA1c, and HOMA%B at 6 months were not significantly different between two groups (P > 0.05). No patient had adverse effects that led to discontinuation of metformin. No cardiovascular event was observed in study period. CONCLUSION: Metformin appears to improve insulin resistance and prevent progression to DM in HIV-infected patients with PreDM. Further study with longer study period is needed to evaluate long-term benefit of metformin. DISCLOSURES: All authors: No reported disclosures.