Acute severe illness in diabetes patients: is tolerating hyperglycemia beneficial?

Gunst, Jan; Berghe, Greet Van den

doi:10.21037/jtd.2016.11.55

Cited by 2 publications

(3 citation statements)

References 26 publications

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“…Even among patients without TB, treatment and management of stress hyperglycemia in critical care is controversial, in particular whether clinical targets should include tight versus normal glucose control [13]. Generally, the association between stress hyperglycemia and adverse outcomes differs by pre-existing diabetes [61].…”

Section: Section 3: Implications Of Stress Hyperglycemia On Tb Treatmmentioning

confidence: 99%

“…While necessary for the immune response to TB disease, this persistent inflammatory state may result in secondary physiologic stress that has untoward negative metabolic effects—such as stress hyperglycemia. Stress hyperglycemia, defined as a transient hyperglycemia induced by acute illness, is distinct from chronic glucose dysregulation of diabetes [12, 13]. Given the increasing global burdens of TB-diabetes comorbidity, further attention is needed to elucidate the role of stress hyperglycemia during TB disease and its impact on TB clinical outcomes and diabetes incidence.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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Among patients with TB disease, the development of stress hyperglycemia may influence the clinical manifestation and treatment response of some patients and can complicate diabetes diagnosis. Research is needed to elucidate the relationship between TB disease and stress hyperglycemia and determine the extent to which stress hyperglycemia impacts TB treatment response. Currently, there is insufficient data to support clinical recommendations for glucose control among patients with TB disease, representing a major barrier for efforts to improve treatment outcomes for patients with TB and diabetes.

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Section: Section 3: Implications Of Stress Hyperglycemia On Tb Treatmmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2018

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“…Food security programs and nutritional supplementation at entry into HIV care may improve low BMI and reduce TB risk [24,28]. Our findings also demonstrate the need for trials to evaluate interventions for optimal glucose levels during early HIV care as there is insufficient data on glucose control in critically ill patients [24,29]. Finally, we identified a PWH subgroup with a considerable increased risk of TB disease.…”

Section: Discussionmentioning

confidence: 74%

Synergy between low BMI and hyperglycemia at baseline increases tuberculosis incidence among people living with HIV

Kyaw

Kumar

Harries

et al. 2021

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Objectives: Low BMI and hyperglycemia are each important risk factors for tuberculosis (TB). However, the contribution of synergy between low BMI and hyperglycemia to risk of TB among people living with HIV (PWH) is unexplored. We compared TB incidence among PWH with different exposure profiles to low BMI (BMI < 18.5 kg/m 2 ) and hyperglycemia (random blood glucose !140 mg/dl). Design and methods:We conducted a cohort study using data of PWH (!15 years) who enrolled in Myanmar's Integrated HIV Care Program between 2011 and 2017. We used their follow-up data until 2018 to determine TB incidence.Results: Among 20 865 PWH included in this study, 7610 (36%) had low BMI only, 1324 (6%) had hyperglycemia only, and 465 (2%) patients had concurrent low BMI and hyperglycemia (joint exposure) at baseline. During a median follow-up of 2.2 years (interquartile range: 0.5, 4.2), 3628 (17%) developed TB [6.7, 95% confidence interval (CI): 6.5,7.0 cases per 100 person-years (PY)]. TB incidence among PWH with joint exposure was 21.0 (95% CI: 18.0, 24.7), with low BMI only was 10.9 (95% CI: 10.4, 11.4), with hyperglycemia only was 5.2 (95% CI: 4.4, 6.3) and with no exposure was 4.6 (95% CI: 4.4, 4.9) cases per 100 PY. The attributable proportion of incident TB due to synergy between low BMI and hyperglycemia was 0.23 (95% CI: 0.06, 0.36). Conclusion:Synergy between low BMI and hyperglycemia was associated with increased excess TB incidence in PWH. TB preventive treatment, nutritional support, and hyperglycemia management should be evaluated as interventions to reduce TB risk in PWH with joint exposure.

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Acute severe illness in diabetes patients: is tolerating hyperglycemia beneficial?

Cited by 2 publications

References 26 publications

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

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

Synergy between low BMI and hyperglycemia at baseline increases tuberculosis incidence among people living with HIV

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