Diabetes mellitus and tuberculosis: pattern of tuberculosis, two‐month smear conversion and treatment outcomes in Guangzhou, China

Abstract

Abstractobjective There is a high burden of both diabetes (DM) and tuberculosis (TB) in China. We evaluated the association between DM and the pattern of disease, 2-month sputum smear conversion and treatment outcomes of patients with TB in Guangzhou, China.method All patients registered with TB from September 2011 to June 2012 were screened for DM and assessed for treatment outcomes in relation to presence or absence of DM and quality of DM control using patient registers, treatment cards and electronic record systems.results There were 1589 patients with TB of whom 189 (12%) had DM. Among those with DM, there was a significantly higher proportion of men, persons aged 35 years and older and persons with smear-positive pulmonary tuberculosis (PTB) (P < 0.01). In patients with DM and new smear-positive PTB, there was a higher proportion who had positive sputum smears at 2 months (21.7% vs. 5.6%, RR 3.85, 95%CI 2.24-6.63), who were lost-to-follow-up (5.2% vs. 1.7%, RR 3.23, 95%CI 1.08-9.63) and who failed treatment (10.3% vs. 2.3%, RR 4.46, 95%CI 1.96-10.18) compared with patients who had no DM. There was no significant association between these adverse outcomes and DM control as measured by 2 and 6-month fasting blood glucose.conclusion Diabetes mellitus in new smear-positive patients with PTB was associated with failure to sputum smear convert at 2 months and adverse treatment outcomes of loss-to-follow-up and failure. Further research is needed to understand the reasons for these findings and to determine whether the current length of treatment of 6 months is adequate.

Prevalence, Predictors and Treatment Outcome of Type 2 Diabetes among Newly Diagnosed Sputum Positive Pulmonary Tuberculosis Patients in Western Cameroon

“…This result is comparable to the result reported in Fiji [31], in Ethiopia [32] and those reported by Kelly Dooley in 2009 [33] but different from the reported study in China [34] in Texas-Mexico [35], Taiwan [36], Maharashtra-India [37], Saudi Arabia [38], and Turkey [39] where sputum conversion among TBDM patient groups were lower. The good sputum conversions observed in both patient groups in our study may be related to good treatment adherence among patients.…”

Risk Factors for Drug-Resistant Tuberculosis

“…Fatty liver may be associated with hepatic toxicity that can potentially lead to sub-therapeutic drug levels and acquired DR [21]. Diabetes may affect TB treatment outcome by delaying time to microbiological response [20] [24]. Thus, it is possible that resistance develops because diabetic patients do not get treatment for long enough.…”

“…There is growing evidence that diabetes mellitus is an important risk factor for TB [19]- [23] and might affect disease presentation and treatment response [20] [24]. WHO estimates that diabetes contribute to about 8% of new cases annually [22].…”

Factors associated with sputum conversion in a multinational population of tuberculosis patients

“…The conversion time has been related with multiple factors including nutritional factors such as anemia, magnesium level, and body mass index (Bhargava et al, 2013;Putri et al, 2014;Agrawal, 2017), history of diabetes mellitus and poor metabolic control (Mi et al, 2013;Nakamura et al, 2014;Sharif, 2015), bacillary load in the diagnosis (D'Souza et al, 2018;Kanda et al, 2015;Gunda, 2017), diagnosis delay and radiological lesions suggestive of extensive damage or cavitation (Mi et al, 2013;Nakamura et al, 2014;Unsematham and Kateruttanakul, 2013;Visser et al, 2012) and drug resistance (Kim et al, 2016;Holtz et al, 2006;Kurbatova et al, 2012). A previously published paper identifies the bacillary load in the diagnosis as the main factor related with sputum conversion in patients attended to in a community hospital in Qatar, but the study is limited by the number of patients studied (64 patients) (Guanche et al, 2016).…”