Association between diabetes mellitus and multi-drug-resistant tuberculosis: evidence from a systematic review and meta-analysis

Abstract

BackgroundDiabetes mellitus (DM) poses a significant risk for the development of active tuberculosis (TB) and complicates its treatment. However, there is inconclusive evidence on whether the TB-DM co-morbidity is associated with a higher risk of developing multi-drug-resistant tuberculosis (MDR-TB). The aim of this meta-analysis was to summarize available evidence on the association of DM and MDR-TB and to estimate a pooled effect measure.MethodsPubMed, Excerpta Medica Database (EMBASE), Web of Science, World Health Organization (WHO), and Global Health Library database were searched for all studies published in English until July 2018 and that reported the association of DM and MDR-TB among TB patients. To assess study quality, we used the Newcastle-Ottawa Scale for cohort and case-control studies and the Agency for Healthcare Research and Quality tool for cross-sectional studies. We checked the between-study heterogeneity using the Cochrane Q chi-squared statistic and I2 and examined a potential publication bias by visual inspection of the funnel plot and Egger’s regression test statistic. The random-effect model was fitted to estimate the summary effects, odds ratios (ORs), and 95% confidence interval (CIs) across studies.ResultsThis meta-analysis of 24 observational studies from 15 different countries revealed that DM has a significant association with MDR-TB (OR = 1.97, 95% CI = 1.58–2.45, I2 = 38.2%, P value for heterogeneity = 0.031). The significant positive association remained irrespective of country income level, type of DM, how TB or DM was diagnosed, and design of primary studies. A stronger association was noted in a pooled estimate of studies which adjusted for at least one confounding factor, OR = 2.43, 95% CI 1.90 to 3.12. There was no significant publication bias detected.ConclusionsThe results suggest that DM can significantly increase the odds of developing MDR-TB. Consequently, a more robust TB treatment and follow-up might be necessary for patients with DM. Efforts to control DM can have a substantial beneficial effect on TB outcomes, particularly in the case of MDR-TB.Systematic review registrationPROSPERO CRD42016045692.Electronic supplementary materialThe online version of this article (10.1186/s13643-018-0828-0) contains supplementary material, which is available to authorized users.

Diabetes among tuberculosis patients and its impact on tuberculosis treatment in South Asia: a systematic review and meta-analysis

“…We found no evidence that diabetes increases the risk of MDR-TB consistent with a previous study 103 . However, our study findings are contrary to results from another systematic review, which showed increased odds of MDR-TB among the TB-diabetes population 99,[106][107][108][109][110] . However, the absence of association in our review might be due to the limited number of studies.…”

Diabetes is associated with genotypically drug-resistant tuberculosis

“…Our findings are in line with previous studies that used phenotypic drug susceptibility testing (DST) and focused on isoniazid and rifampicin (reviewed in Tegegne et al [6]). Several factors might account for the observed association between diabetes and drug resistance mutations.…”

Evaluation of Xpert MTB-RIF guided diagnosis and treatment of rifampicin-resistant tuberculosis in Indonesia: A retrospective cohort study

“…History of multiple previous TB treatment, younger age, and irregular treatment, HIV infection [12], and diabetes [13] have been reported risk factors for RR-TB acquisition [1, 14–16], whereas previous TB treatment, resistance to ofloxacin, being smear-positive at the start of treatment, and no culture conversion by the 3rd month of treatment have been associated with poor MDR-TB treatment outcomes [17–19]. Various studies have reported diagnosis and treatment outcomes of RR-TB using Xpert as rapid DST [20–24].…”