Diabetes mellitus affects the treatment outcomes of drug-resistant tuberculosis: A systematic review and meta-analysis

Abstract

Background Both tuberculosis (TB) and diabetes mellitus (DM) are major public health problems threatening global health. Drug-resistant TB (DR-TB) and impaired immunity caused by DM make controlling TB more difficult. Methods We searched PubMed, Excerpta Medica Database (EMBASE), Web of Science, ScienceDirect and Cochrance Library for literature published in English until July 2022. Papers were limited to those reporting the association between DM and treatment outcomes among DR-TB and multidrug-resistant TB (MDR-TB) patients. The strength of association was presented as odds ratios (ORs) and their 95% confidence intervals (CIs) using the fixed-effects or random-effects models. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were followed for the analysis. Results A total of twenty-five studies involving 16,905 DR-TB patients were included in the meta-analysis, of which 10,124 (59.88%) participants were MDR-TB patients, and 1,952 (11.54%) had DM history. In DR-TB patients, the pooled OR was 1.56 (95% Cl: 1.24–1.96) for unsuccessful outcomes, 0.64 (95% Cl: 0.44–0.94) for cured treatment outcomes, 0.63 (95% Cl: 0.46–0.86) for completed treatment, and 1.28 (95% Cl: 1.03–1.58) for treatment failure. Among MDR-TB patients, the pooled OR was 1.57 (95% Cl: 1.20–2.04) for unsuccessful treatment outcomes, 0.55 (95% Cl: 0.35–0.87) for cured treatment outcomes, 0.66 (95% Cl: 0.46–0.93) for completed treatment and 1.37 (95% Cl: 1.08–1.75) for treatment failure. Conclusion DM is a risk factor for adverse outcomes of DR-TB or MDR-TB patients. Controlling hyperglycemia may contribute to the favourable prognosis of TB.