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

Abstract

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.

Sex-specific prevalence, inequality and associated predictors of hypertension, diabetes, and comorbidity among Bangladeshi adults: results from a nationwide cross-sectional demographic and health survey

“…Notably, older age, sex, educational attainment, occupational status, wealth status, BMI and geographic location were significantly associated with NCDs in the present study which is consistent with the findings of other developing countries 43–50. Like earlier studies, we also found that the risk factors of having comorbidity were significantly associated with older age, sex, higher educational level, regional variation, higher BMI (eg, overweight, obese) and the working status of individuals 32 51 52. This may be a result of older people often suffering from various health issues such as reduced physical activities, poor nutritional status and poor immunity 53.…”

Diabetes in tuberculosis patients: An emerging public health concern and the determinants and impact on treatment outcome

“…[ 5 6 7 20 21 22 23 24 ] Similar to other studies, the prevalence of diabetes in TB patients in our study was significantly higher in the older age group (>50 years), males, smokers, and overweight (BMI >25) patients. [ 5 6 7 20 21 22 23 24 25 26 27 28 29 ] In the current study, similar to a study in the United States, the socioeconomic status was not significantly associated with the presence of diabetes in TB patients. [ 30 ] We also found that diabetes was significantly more common in patients with pulmonary TB and type II treatment category patients.…”

Diabetes among tuberculosis patients and its impact on tuberculosis treatment in South Asia: a systematic review and meta-analysis

“…Findings from subgroup analysis showed that there is a wide difference between the pooled prevalence across the countries; the lowest being 11% (95% CI 10.0, 12.0) in Bangladesh to the highest 24% (95% CI 21.0, 27.0) in Sri-Lanka. Similarly, a large variation in the diabetes prevalence was also seen within countries, ranging from 5% (95% CI 3.0, 8.0) 13 to 66% (95% CI 61.0, 71.0) 32 in India, 8%, (95% CI 4.0, 14.0) 76 to 40% (95% CI 38.0, 41.0) 68 in Pakistan, 4% (95% CI 2.0, 6.0) 80 to 25% (95% CI 21.0, 29.0) 78 in Nepal and 8% (95% CI 7.0, 10.0) 82 to 13% (95% CI 11.0, 14.0) 83 in Bangladesh (Table 1 ). Furthermore, a small reduction in the pooled prevalence of diabetes among the TB population was observed in the pooled analysis of studies limited to more than 300 participants only (19.0%, 95% CI 16.0, 22.0) and studies conducted within 2010–2015 (19.0%, 95% CI 16.0, 22.0).…”

“…Most studies were judged at a high risk of bias for item number three of the selection category description of the non-response rate. Only 12 studies have adequately described the non-response rate in the study 21 , 24 , 27 , 32 , 37 , 38 , 40 , 51 , 56 , 64 , 79 , 83 (Supplementary Table 3 ). The mean NOS score assessing the impact of diabetes among TB treatment outcome was seven (of a possible nine points), suggesting that the high quality of the studies was included in the meta-analysis (Supplementary Table 6 ).…”

“…The main characteristics of the studies included in the review are summarized in Supplementary Table 2. In total, 65 studies with 49,792 TB patients were included in the pooled prevalence for diabetes in tuberculosis patient, out of which 47 studies were from India 13, , 10 from Pakistan [68][69][70][71][72][73][74][75][76][77] , four from Nepal [78][79][80][81] and two studies each from Bangladesh 82,83 and Sri-Lanka 84,85 . However, there were no studies from Bhutan, Maldives, and Afghanistan.…”