Clinical management of combined tuberculosis and diabetes

Crevel, Reinout van; Koesoemadinata, Raspati C; Hill, Philip C.; Harries, Anthony

doi:10.5588/ijtld.18.0340

Cited by 37 publications

(26 citation statements)

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“…Poor glucose control is associated with poorer treatment outcomes [36][37][38] (reviewed in 39 ), and increased risk of developing diabetes associated complications and recurrent TB 40 . Although there is currently limited direct evidence that improved glucose control improves TB treatment outcomes, the high prevalence of poorly controlled blood glucose; even when using the more realistic target of HbA1c% <8% 40 , and including in those reporting to be on regular diabetes medication is worrying.…”

Section: Discussionmentioning

confidence: 99%

Patterns and predictors of co-morbidities in Tuberculosis: A cross-sectional study in the Philippines

White

Edwards

Lee

et al. 2020

Sci Rep

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Diabetes and undernutrition are common risk factors for tB, associated with poor treatment outcomes and exacerbated by tB. We aimed to assess non-communicable multimorbidity (co-occurrence of two or more medical conditions) in filipino tB outpatients, focusing on malnutrition and diabetes. in a crosssectional study, 637 adults (70% male) from clinics in urban Metro Manila (N = 338) and rural Negros occidental (n = 299) were enrolled. Diabetes was defined as HbA1c of ≥6.5% and/or current diabetes medication. Study-specific HIV screening was conducted. The prevalence of diabetes was 9.2% (54/589, 95%CI: 7.0-11.8%) with 52% newly diagnosed. Moderate/severe undernutrition (body mass index (BMi) <17 kg/ 2) was 20.5% (130/634, 95%CI: 17.4-23.9%). Forty percent of participants had at least one co-morbidity (diabetes, moderate/severe undernutrition or moderate/severe anaemia (haemoglobin <11 g/dL)). HIV infection (24.4%, 74/303) was not associated with other co-morbidities (but high refusal in rural clinics). central obesity assessed by waist-to-hip ratio was more strongly associated with diabetes (Adjusted odds Ratio (AoR) = 6.16, 95%CI: 3.15-12.0) than BMI. Undernutrition was less common in men (AoR = 0.44, 95%CI: 0.28-0.70), and associated with previous history of TB (AoR = 1.97, 95%CI: 1.28-3.04) and recent reduced food intake. The prevalence of multimorbidity was high demonstrating a significant unmet need. HIV was not a risk factor for increased non-communicable multimorbidity.

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Section: Discussionmentioning

confidence: 99%

Patterns and predictors of co-morbidities in Tuberculosis: A cross-sectional study in the Philippines

White

Edwards

Lee

et al. 2020

Sci Rep

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“…For HIV/AIDS, the key interventions are HIV testing for presumptive and diagnosed TB patients and timely initiation of antiretroviral therapy (ART) and co-trimoxazole preventive therapy (CPT). For DM, the understanding of what makes a difference is still a work in progress, but promising key interventions include better management and control of DM, the use of metformin, and adjunctive therapy with aspirin and statins for those at risk of cardiovascular disease (Van Crevel et al, 2018).…”

Section: Providing Fast and Effective Treatment For All Those Diagnosmentioning

confidence: 99%

Ending tuberculosis by 2030—Pipe dream or reality?

Chakaya

Harries

Marks

2020

International Journal of Infectious Diseases

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Tuberculosis (TB) remains a major public health threat. In 2018, an estimated 10 million people fell ill with TB and 1.5 million died of the disease. The End TB Strategy envisages an end to TB as a public health threat and has set ambitious targets to reduce TB incidence and mortality by 90% and 95%, respectively, by 2035 compared with 2015. In this paper we describe the progress that is being made towards the achievement of these targets and highlight the challenges that are hampering this progress. The development and deployment of new tools will certainly accelerate progress towards ending TB. We believe that the end of TB is realizable if there are sustained efforts to actively find TB cases, a more robust multi-sectoral approach to tackle social determinants of TB, and improved person-centred health services.

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“…Type 2 diabetes mellitus is a risk factor for TB disease and unfavorable treatment outcomes 15,16 . Our study found a positive association between swab detection and diabetes, while Wood et al reported a negative association between the two 4 .…”

Section: Discussionmentioning

confidence: 99%

Molecular detection of Mycobacterium tuberculosis from buccal swabs among adult in Peru

Mesman

Calderón

Pollock

et al. 2020

Sci Rep

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Tuberculosis (TB) diagnosis relies on a sputum sample, which cannot be easily obtained from all symptomatic patients. Mycobacterium tuberculosis DNA can be detected from oral swabs, a noninvasive, safe alternative sample type; however, reported sensitivities have been variable and likely depend on sample collection, processing procedures and host characteristics. We analyzed three buccal swab samples from 123 adults with culture-confirmed TB in Lima, Peru. We compared the sensitivity and specificity of two sample collection devices (OmniSwab and EasiCollect FTA cards) and examined factors associated with detection. DNA was extracted with a commercially available kit and detected via real-time PCR IS6110 amplification. Overall sensitivity for buccal samples was 51% (95% Confidence Interval [CI] 42–60%). Specificity from a single sample among healthy controls was 96.7% (95% CI 83–99.9%). Positive sputum smear and cavitary disease, correlates of disease burden, were associated with detection via buccal swab. Although we observed higher sensitivities with the Omniswab samples, this appeared to be due primarily to differences in patient characteristics (e.g., cavitary disease). Overall, our findings support the potential for a buccal sample-based TB assay. Future work should focus on assay optimization and streamlining the assay workflow.

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Clinical management of combined tuberculosis and diabetes

Cited by 37 publications

References 0 publications

Patterns and predictors of co-morbidities in Tuberculosis: A cross-sectional study in the Philippines

Patterns and predictors of co-morbidities in Tuberculosis: A cross-sectional study in the Philippines

Ending tuberculosis by 2030—Pipe dream or reality?

Molecular detection of Mycobacterium tuberculosis from buccal swabs among adult in Peru

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