An Observational Study to Determine the Impact of Glycaemic Control on Presentation of Drug Sensitive and Drug Resistant Pulmonary Tb in Type 2 Diabetes

Abstract

BACKGROUND There is a strong correlation between the two diseases, diabetes and tuberculosis, with impact of one on the other. Poor glycaemic control causes poor outcome of tuberculosis treatment and that can be observed radiologically and microbiologically beside clinical observation.The aim of the study is to study the impact of glycemic control on presentation (clinical, radiological and microbiological) of drug sensitive and drug resistant pulmonary TB in type 2 diabetes. MATERIALS AND METHODSThis is an observational cross-sectional study. Patients above 18 years, having PTB with DM over one year were included. PTB with other conditions like HIV, Pregnancy, Connective tissue disorders, Chronic renal failure, Chronic liver disease, Malignancy, on longterm steroid use or cytotoxic drug therapy or on immunosuppressive drugs were not included in this study. Glycemic control was assessed by A1c < 7 as controlled and > 7 as uncontrolled. Clinical, Microbiological and Radiographic parameters of the patients were studied in respect to their glycemic control. RESULTS263 PTB patients who were screened for the study, out of which 94 were diabetic. The prevalence of D Min PTB patients was found to be 35.7% (out of 180 drug-sensitive PTB patients 68 were diabetic and out of 83 drug resistant PTB patients 26 were diabetic). The overall mean age was (50 ± 9) years, maximum no. of patients (60%) were in 40 -60 years' age group, 70% males with mean A1c (8.54 ± 0.03), 81% had uncontrolled glycemic status and 100% had cough with mean A1c (8.47 ± 0.03). 81% were sputum AFB positive with mean A1c (8.64 ± 0.014), 75.5% had lower lung field abnormalities with mean A1c (8.61 ± 0.094), 12.57% upper lung field with mean A1c (7.53 ± 0.012), 9.5% both lung fields with mean A1c (9.19 ± 0.082), 84% had infiltrative lesions with mean A1c (8.45 ± 0.017) and 25.5% had cavities with high mean A1c (10.04 ± 0.029). CONCLUSIONThe association between DM and TB is the most emerging challenge for global TB control. Poor glycemic control has significant effect on sputum smear positivity, more cavity formation and lower lung field involvement with no effect on clinical symptom. Hence, with the help of this study, it can be concluded that screening for DM should be performed routinely in patients with TB that may improve treatment outcomes. Submission 30-12-2017, Peer Review 27-01-2018, Acceptance 01-02-2018, Published 12-02-2018. Corresponding Author: Dr. Tariq Mahmood, Professor and HOD, Department of Pulmonary Medicine, MLN Medical College, Allahabad-211001, Uttar Pradesh, India. E-mail: mlnmctariqmahmood@gmail.com DOI: 10.14260/jemds/2018 An estimated 10.4 million people fell ill with TB in 2016: 90% were adults, 65% were male, 10% were people living with HIV (74% in Africa) and 56% were in five countries: India, Indonesia, China, the Philippines and Pakistan. Drugresistant TB is a continuing threat to world community. In 2016, there were 6 lakh new cases with resistance to rifampicin, the most effective first-line drug, of whi...