We sought to determine if the risk of T2DM is indeed heightened in nondiabetic ART naïve Ugandan PLHIV over the first 48 weeks on DTG. The objective of this report is to prioritize the needs for research addressing those gaps in the existing literature on management of insulin-requiring diabetes by engaging expert stakeholders using a modified Delphi method.Following reports of anti-retroviral therapy (ART) experienced Ugandan people living with HIV (PLHIV) presenting with diabetic ketoacidosis weeks to months following a switch to dolutegravir (DTG), the Uganda Ministry of Health recommended withholding DTG in both ART naïve and experienced PLHIV with diabetes mellitus (T2DM), as well as 3-monthly blood glucose monitoring for patients with T2DM risk factors. However, the review also identified several important gaps in the evidence. Thus, the addition of this monitoring method to SMBG and intensive insulin therapy can assist in achieving glycemic targets in individuals with type 1 diabetes. Even though CSII and MDI without rt-CGM have similar effects on HbA1c, the addition of rt-CGM to CSII is superior to MDI/SMBG in lowering HbA1c. The review also found evidence that real-time continuous glucose monitoring (rt-CGM) is superior to self-monitoring of blood glucose (SMBG) in lowering HbA1c, without altering the risk balance of severe hypoglycemia, particularly among those who are compliant with wearing the monitoring device. Intensive insulin therapy delivered by both methods resulted in similar rates of severe hypoglycemia for adolescents and adults with type 1 diabetes. The review found that intensive insulin therapy delivered either by continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI) is equally effective in lowering glycated hemoglobin (HbA1c) levels in adolescents and adults with type 1 diabetes. Our recent systematic review examined specific questions about the comparative effectiveness of insulin delivery and glucose monitoring methods. This report is from AHRQ's series on Future Research Needs Projects.

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