Stress Hyperglycemia in Patients with Tuberculosis Disease: Epidemiology and Clinical Implications

Magee, Matthew J.; Salindri, Argita D.; Kyaw, Nang Thu Thu; Auld, Sara C.; Haw, J. Sonya; Umpiérrez, Guillermo E.

doi:10.1007/s11892-018-1036-y

Cited by 35 publications

(30 citation statements)

References 90 publications

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“…Of those who did not report a diabetes diagnosis, 29% still had elevated RBG. Incident TB is associated with hyperglycemia that may resolve over the course of TB treatment independent of diabetes interventions, but may also be a prognostic marker of poor short-term outcomes and longer-term elevated risk of diabetes [6, 29–32].…”

Section: Discussionmentioning

confidence: 99%

Interaction of nutritional status and diabetes on active and latent tuberculosis: a cross-sectional analysis

et al. 2019

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Background Malnutrition and diabetes are risk factors for active tuberculosis (TB), possible risk factors for latent TB infection (LTBI), and may interact to alter their effect on these outcomes. Studies to date have not investigated this interaction. Methods We enrolled 919 newly diagnosed active TB patients and 1113 household contacts at Primary Health Centres in Puducherry and Tamil Nadu, India from 2014 to 2018. In cross-sectional analyses, we used generalized estimating equations to measure additive and multiplicative interaction of body mass index (BMI) and diabetes on two outcomes, active TB and LTBI. Results Among overweight or obese adults, active TB prevalence was 12-times higher in diabetic compared to non-diabetic participants, 2.5-times higher among normal weight adults, and no different among underweight adults ( P for interaction < 0.0001). Diabetes was associated with 50 additional active TB cases per 100 overweight or obese participants, 56 per 100 normal weight participants, and 17 per 100 underweight participants ( P for interaction < 0.0001). Across BMI categories, screening 2.3–3.8 active TB patients yielded one hyperglycemic patient. LTBI prevalence did not differ by diabetes and BMI*diabetes interaction was not significant. Conclusions BMI and diabetes are associated with newly diagnosed active TB, but not LTBI. Diabetes conferred the greatest risk of active TB in overweight and obese adults whereas the burden of active TB associated with diabetes was similar for normal and overweight or obese adults. Hyperglycemia was common among all active TB patients. These findings highlight the importance of bi-directional diabetes-active TB screening in India. Electronic supplementary material The online version of this article (10.1186/s12879-019-4244-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Interaction of nutritional status and diabetes on active and latent tuberculosis: a cross-sectional analysis

et al. 2019

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“…1 There is evidence that the presence of clinical TB disease drives stress hyperglycaemia, impacting on clinical outcomes and response to treatment. 16 As rates of diabetes continue to rise, and the TB epidemic continues, there is a pressing need for bidirectional screening in countries facing the double burden of TB and diabetes. Work in India has shown success at screening newly diagnosed TB cases for diabetes, 17 due to the availability of a simple screening blood test (HbA1c) and the use of existing systems established to screen TB cases for HIV.…”

Section: Diabetes and Specific Infectionsmentioning

confidence: 99%

“…Sepsis-related hyperglycaemia may be a risk factor for future development of T2DM, 101 and stress hyperglycaemia induced by chronic infections such as TB may contribute to the global burden of diabetes. 16…”

Section: Mechanisms Of Increased Susceptibility To Infection In Diabetesmentioning

confidence: 99%

The double burden of diabetes and global infection in low and middle-income countries

Dunachie

Chamnan

2018

Transactions of the Royal Society of Tropical Medicine and Hygiene

135

106

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Four out of five people in the world with diabetes now live in low- and middle-income countries (LMIC), and the incidence of diabetes is accelerating in poorer communities. Diabetes increases susceptibility to infection and worsens outcomes for some of the world’s major infectious diseases such as tuberculosis, melioidosis and dengue, but the relationship between diabetes and many neglected tropical diseases is yet to be accurately characterised. There is some evidence that chronic viral infections such as hepatitis B and HIV may predispose to the development of type 2 diabetes by chronic inflammatory and immunometabolic mechanisms. Helminth infections such as schistosomiasis may be protective against the development of diabetes, and this finding opens up new territory for discovery of novel therapeutics for the prevention and treatment of diabetes. A greater understanding of the impact of diabetes on risks and outcomes for infections causing significant diseases in LMIC is essential in order to develop vaccines and therapies for the growing number of people with diabetes at risk of infection, and to prioritise research agendas, public health interventions and policy. This review seeks to give an overview of the current international diabetes burden, the evidence for interactions between diabetes and infection, immune mechanisms for the interaction, and potential interventions to tackle the dual burden of diabetes and infection.

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“…A study in Tanzania observed a stronger TB/DM association among people living with HIV [ 13 ], while another Tanzanian study observed stronger TB/DM association in HIV-1–uninfected persons (OR, 4.2 [95% CI, 1.5–11.6]) compared with people living with HIV (OR, 0.1 [95% CI, .01–1.8]) [ 14 ]. These 3 diseases interact, with the potential to influence risk of disease and prognosis and to complicate clinical management [ 15 ].…”

mentioning

confidence: 99%

Tuberculosis, Human Immunodeficiency Virus, and the Association With Transient Hyperglycemia in Periurban South Africa

Kubjane

Berkowitz

Goliath

et al. 2019

Clinical Infectious Diseases

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Background Diabetes mellitus (DM) increases tuberculosis (TB) risk. We assessed the prevalence of hyperglycemia (DM and impaired glucose regulation [IGR]) in persons with TB and the association between hyperglycemia and TB at enrollment and 3 months after TB treatment in the context of human immunodeficiency virus (HIV) infection. Methods Adults presenting at a Cape Town TB clinic were enrolled. TB cases were defined by South African guidelines, while non-TB participants were those who presented with respiratory symptoms, negative TB tests, and resolution of symptoms 3 months later without TB treatment. HIV status was ascertained through medical records or HIV testing. All participants were screened for DM using glycated hemoglobin and fasting plasma glucose at TB treatment and after 3 months. The association between TB and DM was assessed. Results Overall DM prevalence was 11.9% (95% confidence interval [CI], 9.1%–15.4%) at enrollment and 9.3% (95% CI, 6.4%–13%) at follow-up; IGR prevalence was 46.9% (95% CI, 42.2%–51.8%) and 21.5% (95% CI, 16.9%–26.3%) at enrollment and follow-up. TB/DM association was significant at enrollment (odds ratio [OR], 2.41 [95% CI, 1.3–4.3]) and follow-up (OR, 3.3 [95% CI, 1.5–7.3]), whereas TB/IGR association was only positive at enrollment (OR, 2.3 [95% CI, 1.6–3.3]). The TB/DM association was significant at enrollment in both new and preexisting DM, but only persisted at follow-up in preexisting DM in patients with HIV-1 infection. Conclusions Our study demonstrated high prevalence of transient hyperglycemia and a significant TB/DM and TB/IGR association at enrollment in newly diagnosed DM, but persistent hyperglycemia and TB/DM association in patients with HIV-1 infection and preexisting DM, despite TB therapy.

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Stress Hyperglycemia in Patients with Tuberculosis Disease: Epidemiology and Clinical Implications

Cited by 35 publications

References 90 publications

Interaction of nutritional status and diabetes on active and latent tuberculosis: a cross-sectional analysis

Interaction of nutritional status and diabetes on active and latent tuberculosis: a cross-sectional analysis

The double burden of diabetes and global infection in low and middle-income countries

Tuberculosis, Human Immunodeficiency Virus, and the Association With Transient Hyperglycemia in Periurban South Africa

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