Glycated hemoglobin screening identifies patients admitted for retreatment of tuberculosis at risk for diabetes in Tanzania

Abstract

Introduction World Health Organization recommendations of bidirectional screening for tuberculosis (TB) and diabetes have been met with varying levels of uptake by national TB programs in resource-limited settings. Methodology Kibong’oto Infectious Diseases Hospital (KIDH) is a referral hospital for TB from northern Tanzania, and the national referral hospital for multidrug-resistant (MDR)-TB. Glycated hemoglobin (HgbA1c) testing was done on patients admitted to KIDH for newly diagnosed TB, retreatment TB, and MDR-TB, to determine the point prevalence of diabetes (HgbA1c ≥ 6.5%) and prediabetes (HgbA1c 5.7%– 6.4%). Results Of 148 patients hospitalized at KIDH over a single week, 59 (38%) had no prior TB treatment, 22 (15%) were retreatment cases, and 69 (47%) had MDR-TB. Only 3 (2%) had a known history of diabetes. A total of 144 (97%) had successful screening, of which 110 (77%) had an HgbA1c ≤ 5.6%, 28 (19%) had ≥ 5.7 < 6.5, and 6 (4%) had ≥ 6.5. Comparing subjects with prediabetes or diabetes to those with normal A1c levels, retreatment patients were significantly more likely to have a A1c ≥ 5.7% (odds ratio: 3.2, 95% CI: 1.2–9.0; p = 0.02) compared to those without prior TB treatment. No retreatment case was a known diabetic, thus the number needed to screen to diagnose one new case of diabetes among retreatment cases was 11. Conclusions Diabetes prevalence by HgbA1c was less common than expected, but higher HgA1c values were significantly more frequent among retreatment cases, allowing for a rational, resource-conscious screening approach.

Protocol for establishing an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) for integrating care of communicable and non-communicable diseases using tuberculosis and diabetes as a case study

“… 12 13 Likewise, the incidence of dual diagnosed patients with TB/DM ranges from 4% of all patients with TB in rural areas to 17% in urban settings. 14 15 Evidence has shown that TB/DM death is fivefold higher compared with patients with TB without DM and that death primarily occurred early, in the first 3 months of TB treatment. 14 15 This high and early mortality from TB/DM in Tanzania is due to both programmatic and biological factors.…”

“… 14 15 Evidence has shown that TB/DM death is fivefold higher compared with patients with TB without DM and that death primarily occurred early, in the first 3 months of TB treatment. 14 15 This high and early mortality from TB/DM in Tanzania is due to both programmatic and biological factors. 16 The TB and DM services are not linked and these separated service lines lead to delayed interventions for both diseases.…”

Availability and readiness of diabetes health facilities to manage tuberculosis in Tanzania: a path towards integrating tuberculosis-diabetes services in a high burden setting?

“…The WHO recommend bidirectional screening of DM and TB [20], however, this has been implemented to varying degrees in LMICs such as Tanzania [6]. Bidirectional screening for TB and DM is reported to give high yield for TB among DM patients and vice versa [21–23].…”

Development and performance of CUHAS-ROBUST application for pulmonary rifampicin-resistance tuberculosis screening in Indonesia

“…The authors consider body mass index, as it shows an inverse correlation to the rifampicin concentration in the body [ 46 ]. Another point is the authors did not focus on the DM status but the latest Hba1c point [ 47 ]. This is important as some of the DM patients may have controlled HbA1c which possibly reduces the occurrence of DR-TB.…”