Diabetes Is a Risk Factor for Pulmonary Tuberculosis: A Case-Control Study from Mwanza, Tanzania

Faurholt‐Jepsen, Daniel; Range, Nyagosya; PrayGod, George; Jeremiah, Kidola; Faurholt‐Jepsen, Maria; Aabye, Martine G.; Changalucha, John; Christensen, Dirk L.; Pipper, Christian Bressen; Krarup, Henrik; Witte, Daniel R.; Andersen, Aase Bengaard; Friis, Henrik

doi:10.1371/journal.pone.0024215

Cited by 101 publications

(121 citation statements)

References 29 publications

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Section: Discussionmentioning

confidence: 99%

“…2 Other studies in the Pacific and elsewhere have shown a higher prevalence of DM among TB patients than in the general population. [12][13][14] In an unpublished study from Kiribati, where the prevalence of both diseases is relatively high, the prevalence of DM in TB patients was twice that of the general population (37% vs. 19%, P  0.001).Other studies from outside the Pacific Islands region have also reported a higher prevalence of DM among TB patients than in the general population. In Tanzania, the prevalence of DM among TB patients was 16.7% compared to 9.4% in a group of matched controls.…”

mentioning

confidence: 99%

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Sputum smear conversion and treatment outcomes for tuberculosis patients with and without diabetes in Fiji

Prasad

Gounder

Varman

et al. 2014

public health action

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Fiji is a low tuberculosis (TB) burden country, with a TB incidence rate of 24 cases per 100 000 population and a high treatment success rate of 90% (2012 data). 1 However, diabetes mellitus (DM) is very common in Fiji, and its prevalence is thought to be increasing. The STEPwise approach to Surveillance (STEPs) study conducted in 2002 reported a population prevalence of 16% for DM. 2 A more recent estimate, using a different methodology, gave a DM prevalence among adults in Fiji of 10.9%, with impaired glucose tolerance in a further 11.0%. 3 This remarkably high prevalence of DM is a matter of concern for TB control in Fiji. Published data from other settings have concluded that people with DM have a significantly increased risk of developing TB and worse treatment outcomes, with a higher risk of mortality and treatment failure during anti-tuberculosis treatment than among patients without DM. [4][5][6] In response to this evidence, the Fiji National Tuberculosis Programme (NTP) introduced random blood glucose (RBG) testing to screen for DM in all registered TB patients in 2011. 7 A recent local study reported DM in 14% of TB patients in Fiji. 8 It has been noted by local clinical and public health staff that sputum smear-positive TB patients with DM take longer to convert to smear-negative than TB patients without DM, and that they thus require longer periods of hospitalisation. However, this observation has not been verified empirically, and there are no published data from Fiji reporting sputum smear conversion or treatment response in TB patients with and without DM.In the present study, we aimed to evaluate treatment outcomes and sputum smear conversion in TB patients with DM and compare these indicators in TB patients without DM. METHODS Study designThis was a retrospective descriptive study using routinely collected data from the TB register and in-patient folders from three TB treatment hospitals in Fiji. SettingFiji is an island nation, located in the Pacific Ocean, classified as an upper middle-income economy. 9 It comprises 332 islands, of which 110 are inhabited. The population of 837 231 comprises 56.8% i-Taukei (indigenous Fijians) and 37.5% Fijians of Indian descent; the remaining 5.7% are from other ethnic backgrounds. 10 The Fiji NTP is largely funded by the government, and TB diagnosis and treatment are provided free of charge. Three government hospitals provide TB services for the entire country; the private sector is not involved in TB control. All patients diagnosed with TB are registered as TB cases and treated at one of the three TB treatment centres. The majority of TB patients are admitted for the 2-month intensive phase of treatment, during which they receive anti-tuberculosis treatment and clinical follow-up. Clinical evaluation on admission routinely includes a full medical history and RBG screening if the patient is not known to have DM. If RBG is 6.1 mmol/l, fasting blood glucose (FBG) is tested. If the FBG is 7 mmol/l, 8 patients are diagnosed as having DM and referred to a ph...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Sputum smear conversion and treatment outcomes for tuberculosis patients with and without diabetes in Fiji

Prasad

Gounder

Varman

et al. 2014

public health action

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“…Résultats : On a analysé 1376 patients, parmi lesquelles 750 femmes (55%). L'âge moyen des patients dans les polycliniques a été de 53,5 années (IC95% 52,2-54,8), avec une durée moyenne du diabète de 8,1 années (7,(6)(7)(8)7). Sur l'ensemble des patients, 5,6% ont signalé des antécédents de TB, fréquence similaire à celle existant 20 ans plus tôt (1990) en Tanzanie.…”

Section: Resultsunclassified

“…All were performed in Tanzania: two in 1990, one of which evaluated TB in patients with DM 4 and the other DM in patients with TB; 5 and the third in 2011, which evaluated DM in patients with TB. 6 The human immunodefi ciency virus (HIV) epidemic that emerged in the late 1980s signifi cantly increased the overall incidence of TB in countries in Public Health Action Important co-morbidity in DM patients 149 blood sugar/fasting blood sugar, glycated hemoglobin (HbA1c), symptoms, clinical fi ndings and medications prescribed during the visit. At the end of the patient encounter, the data were entered into an Access (Microsoft Corp, Redmond, WA, USA) database by trained staff.…”

Section: Diabetes Managementmentioning

confidence: 99%

Important co-morbidity in patients with diabetes mellitus in three clinics in Western Kenya

Kirui¹,

Pastakia²,

Kamano³

et al. 2012

public health action

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“…9 Moreover, DM patients with smearpositive pulmonary TB have a higher probability of failure of the sputum smear conversion after 2 months of therapy than patients without DM. 10,11 DM constitutes a risk factor for active TB and might influence the disease presentation and response to treatment. 12,13 On the other hand, TB may induce glucose intolerance and aggravate glycemic control in patients with DM.…”

mentioning

confidence: 99%

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

Mahmood¹,

Verma²,

Ahmad³

et al. 2018

jemds

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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...

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Diabetes Is a Risk Factor for Pulmonary Tuberculosis: A Case-Control Study from Mwanza, Tanzania

Cited by 101 publications

References 29 publications

Sputum smear conversion and treatment outcomes for tuberculosis patients with and without diabetes in Fiji

Sputum smear conversion and treatment outcomes for tuberculosis patients with and without diabetes in Fiji

Important co-morbidity in patients with diabetes mellitus in three clinics in Western Kenya

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

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