Clinical profile of diabetes mellitus in tuberculosis

Ogbera, Anthonia O; Kapur, Anil; Abdur-Razzaq, Hussein; Harries, Anthony; Ramaiya, Kaushik; Adeleye, Olufunmilayo; Kuku, S. F.

doi:10.1136/bmjdrc-2015-000112

Cited by 34 publications

(28 citation statements)

References 19 publications

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“…This difference can be explained by the parallel increase of the prevalence of T2DM with age, as has been previously reported (Delgado-Sanchez et al, 2015;Hongguang et al, 2015;Perez-Navarro et al, 2015;Raghuraman, Vasudevan, Govindarajan, Chinnakali, & Panigrahi, 2014). Our study supports the concept that family history of diabetes (reported in 68% of patients with TB-T2DM, OR 5.04, IC 95% 3.4, 7.4, p< 0.001) is a risk factor for development of TB (Ogbera et al, 2015;PerezNavarro et al, 2015;Chittoor et al, 2013).…”

Section: Discussionsupporting

confidence: 90%

The effect size of type 2 diabetes mellitus on tuberculosis drug resistance and adverse treatment outcomes

Perez-Navarro

Restrepo²,

Fuentes-Domínguez³

et al. 2017

Tuberculosis

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2 AbstractObjective: To evaluate the effect size of type 2 diabetes mellitus (T2DM) on tuberculosis (TB) treatment outcomes and multi drug resistance (MDR). Methods:A cohort with 507 individuals with diagnosed TB included 183 with coexistence of T2DM and TB (TB-T2DM). Participants were identified at the time of TB diagnosis and followed during the course of TB treatment. Then we computed relative risks and adjustments by Cox proportional hazards for outcome variables (drug resistance, death, relapse, treatment failure), and the size of their effect as Cohen's-d. Results:Patients with TB-T2DM were more likely to remain positive for acid-fast bacilli after two months of anti-TB treatment RR= [2.01 (95% CI: 1.3, 3.1)], to have drug resistant (DR) [OR 3.5 (1.8, 6.7)] and multi-drug resistant (MDR) TB [OR 3.5 (1.8, 7.1)]. The Cohen's-d for DR or MDR in T2DM was 0.69 when compared with non-DM subjects. The T2DM patients had higher odds of resistance to isoniazid (OR 3.9, 95% CI 2.01, 7.9), rifampicin (OR 3.4, 95%CI: 1.6, 7.2) and pyrazinamide (OR 9.4, 95% CI 2.8, 25.6), and their effect sizes were ≥ 0.67. Patients with TB-T2DM (versus no DM) were more likely to present with MDR TB (HR 3.1; 95% CI 1.7, 5.8; p <0.001), treatment failure (HR 2.04; 95% CI 1.07, 3.8; p 0.02) and relapse (HR 2.1; 95% CI 1.2, 3.8; p 0.002), with effect sizes ≥0.39. Conclusion:T2DM showed a substantial contribution to the presence of DR or MDR-TB and to adverse clinical outcomes during and after TB treatment. Our findings support the importance for routine screening of T2DM among newly-diagnosed TB patients in order to stratify them for immediate DR assessment, and highlight the need for clinical trials to evaluate variations to the standard TB treatment in TB-T2DM to prevent adverse treatment outcomes.Keywords: Tuberculosis, type 2 diabetes mellitus, effect, size 3 IntroductionThe overall prevalence of diabetes mellitus (DM) has increased rapidly as a result of an aging population, urbanization and associated changes lifestyle during the last decades. The International Diabetes Federation (IDF) estimated in 2015 the worldwide prevalence of type 2 diabetes mellitus (T2DM) was 8.8% (415 million people) (IDF). In Mexico, the prevalence of T2DM increased by 4.7% from 1998 to 2012, with a morbidity rate of 358.2 per 100 000 in 2012 (Sistema.Nacional. de.Vigilancia.Epidemiológica, 2013). Meanwhile, the World Health Organization (WHO) reported 9.5 million new cases of TB in 2014 and 1.5 million deaths.( WHO, 2015) In Mexico, the tuberculosis (TB) incidence was 23 per 100,000, reflecting a serious public health problem (Delgado-Sanchez et al., 2015).The increase in prevalence of T2DM has had a significant impact on tuberculosis comorbidity, with prevalence rates ranging from 10% to 30%, mainly affecting developing countries, including Some studies report that T2DM increased two to three times the risk of TB (Dooley & Chaisson, 2009;Jeon & Murray, 2008;Perez-Navarro et al., 2015), and diminishes the success of treatment cure (Baker et al., 2011...

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Section: Discussionsupporting

confidence: 90%

The effect size of type 2 diabetes mellitus on tuberculosis drug resistance and adverse treatment outcomes

Perez-Navarro

Restrepo²,

Fuentes-Domínguez³

et al. 2017

Tuberculosis

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“…Previous similar studies reported a consistent finding in which TB-diabetes cases were older than TB cases without diabetes and the difference was significant [20,22,25]. This could be described as age related diabetes because Type 2 diabetes frequently develops in older adults.…”

Section: Discussionsupporting

confidence: 58%

TB-diabetes comorbidity and associated factors in Maekel Zone, Eritrea: A cross sectional study.

Araia

Mebrahtu²,

Tewelde³

et al. 2019

Preprint

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Background : In Eritrea, no study document the true burden of TB-diabetes comorbidity. However, diabetes has been constantly increasing with a prevalence of 3.4 %. Similarly, even though TB notification is showing a declining trend the prevalence is 123/100,000 population. With an increasing diabetes trend, the country is at higher risk of rising TB-diabetes comorbidity which can further complicate TB care, control and prevention activities. Thus, this study was conducted to assess the prevalence of diabetes among pulmonary positive TB patients and its influencing factors in Maekel zone, Eritrea. Methods: This study was a cross sectional study conducted in all (11) TB diagnostic and treatment sites of Maekel zone. All consecutive pulmonary positive TB cases who were registered during the period of 2015-2018 in the national TB treatment register and were eligible included in the analysis. Pretested data extraction tool was used to collect the required information. Data analysis was done by SPSS version 23. Simple frequencies, percentages and means were used to describe the data. Chi-square test and logistic regression analysis was also performed. Results: A total of 490 pulmonary positive TB cases were eligible for the study and the overall prevalence of diabetes among pulmonary positive TB cases was 4.3%. Univariate logistic regression showed that participants with an older age (45-90) were more likely to have TB-diabetes comorbidity (COR: 4.397[CI: 1.675-11.545], p<0.01) than those aged 10-44 years old. In addition, subjects whose weight was 65kg and above were more likely (COR: 7.647[CI: 1.965-29.758], p<0.01) to have TB- diabetes comorbidity than those with lower body weight. Conclusion: TB-diabetes comorbidity observed in this study is low but given the growing diabetes trend in the country, an integrated TB-DM services should be given regularly on full scale at all health facilities.

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“…This means with increasing BMI, although the risk of diabetes increases, the risk of TB decreases [29]. But the increasing prevalence of diabetes, as evident through our study, suggests more occurrence of TB, hence raising the co-morbidity of TB and diabetes [30]. Therefore, the importance of undertaking interventions to reduce TB-diabetes comorbidity cannot be neglected.…”

Section: Discussionmentioning

confidence: 87%

Double Trouble: Prevalence and Factors Associated with Tuberculosis and Diabetes Comorbidity in Bangladesh

et al. 2016

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BackgroundDiabetes among tuberculosis patients increases the risk of tuberculosis treatment failure, death, and development of multidrug-resistant tuberculosis. Yet, there is no data is available in Bangladesh on the prevalence of diabetes among tuberculosis patients. The objective of the current study was to estimate prevalence and identify factors associated with tuberculosis-diabetes co-morbidity among TB patients enrolled in the Directly Observed Treatment, Short course program.MethodsA community based cross-sectional quantitative study was conducted among 1910 tuberculosis patients living in six urban and eleven rural areas among whom Oral Glucose Tolerance Test (those who fasted) and Random Blood Sugar test (those who did not fast) were performed. Besides glucose levels, data on socio-demographic information, family history of diabetes and anthropometric measurements (height and weight) were also collected.ResultAmong the 1910 TB patients who participated in screening for diabetes, 245 (12.8%) were found to have diabetes and 296 (15.5%) to have pre-diabetes. Out of those who had diabetes, 34.7% were newly diagnosed through the current study and 65.3% already knew their status. Among those who were found to have prediabetes, 27 (9.1%) had impaired Fasting Blood Glucose (FBG), 230 (77.7%) had Impaired Glucose Tolerance (IGT), and 39 (13.2%) had both Impaired FBG and IGT. Older age, higher BMI, higher education (secondary level and above), being married, participation in less active work, and family history of diabetes are associated with higher prevalence of diabetes.ConclusionWe observed a higher prevalence of diabetes and pre-diabetes in TB patients than reported previously in Bangladesh among the general population which may challenge TB and diabetes control in Bangladesh. Diabetes diagnosis, treatment and care should be integrated in the National TB Program.

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Clinical profile of diabetes mellitus in tuberculosis

Cited by 34 publications

References 19 publications

The effect size of type 2 diabetes mellitus on tuberculosis drug resistance and adverse treatment outcomes

The effect size of type 2 diabetes mellitus on tuberculosis drug resistance and adverse treatment outcomes

TB-diabetes comorbidity and associated factors in Maekel Zone, Eritrea: A cross sectional study.

Double Trouble: Prevalence and Factors Associated with Tuberculosis and Diabetes Comorbidity in Bangladesh

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