Impact of Diabetes and Smoking on Mortality in Tuberculosis

Reed, George W.; Choi, Hong-Jo; Lee, So Young; Lee, Myungsun; Kim, Youngran; Park, Hyemi; Lee, Jong-Seok; Zhan, Xin; Kang, Hyungseok; Hwang, Sung-Kyun; Carroll, Matthew; Cai, Ying; Cho, Sang Nae; Barry, Clifton E.; Via, Laura E.; Kornfeld, Hardy

doi:10.1371/journal.pone.0058044

Cited by 79 publications

(93 citation statements)

References 19 publications

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“…The prevalence of DM and smoking was higher among the younger age groups. 3 It has been recommended that TB patients should be routinely screened for both of these risk factors and that, if present, they should be addressed to improve TB treatment outcomes. 3 India, with an annual incidence of 2.2 million TB cases, has the highest TB burden in the world.…”

Section: Resultsmentioning

confidence: 99%

“…3 It has been recommended that TB patients should be routinely screened for both of these risk factors and that, if present, they should be addressed to improve TB treatment outcomes. 3 India, with an annual incidence of 2.2 million TB cases, has the highest TB burden in the world. 4 Nearly 63 million people (∼8% of the adult population aged ⩾20 years) are estimated to have DM, and 120 million are estimated to be tobacco smokers (∼14% of the adult population).…”

Section: Resultsmentioning

confidence: 99%

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Diabetes mellitus and smoking among tuberculosis patients in a tertiary care centre in Karnataka, India

Jali

Mahishale

Hiremath

et al. 2013

public health action

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Diabetes mellitus (DM) and smoking are risk factors for adverse outcomes in the treatment of tuberculosis (TB). In a tertiary care hospital at Belgaum in the South Indian State of Karnataka, all TB patients aged ⩾18 years consecutively diagnosed from February to September 2012 were evaluated for DM and smoking. Of 307 TB patients, 35.5% were found to have DM, 9.8% were current smokers, and 3.6% had DM and were also smokers. Measures to assess and address both these factors need to be taken into account during TB treatment. consecutively during the period February to September 2012 who were referred to the DOTS centre for TB treatment were included in the study. All eligible patients were asked about their history of DM. If there was no known history of DM, patients underwent random blood glucose (RBG) tests using a glucometer. Patients with RBG levels ⩾ 110 mg/dl (>6.1 mM) were requested to undergo a fasting blood glucose (FBG) test. Patients with FBG levels ⩾ 126 mg/dl (⩾7 mM) and between 110 and 125 mg/dl (6.1-7.0 mM) were diagnosed with DM and IFG, respectively, and referred for diabetes care. Simultaneously, TB patients with a history of at least one episode of tobacco smoking in the last 3 months were identifi ed as 'current smokers'. The procedure for screening, recording (in a separate register) and reporting (on a standard quarterly reporting form) has been described in detail elsewhere. 6 AFFILIATIONS Data variables, data entry and analysisThe following data were extracted from the registers: age, sex, type of TB, RBG levels, FBG levels, and history of at least one episode of smoking in the last 3 months. The data were entered into a pre-structured data entry form created in EpiData Version 3.1 (EpiData Association, Odense, Denmark) and analysed. The data were summarised by frequencies and proportions. Ethics approvalThis project protocol was reviewed and approved by the International Union Against Tuberculosis and Lung Disease Ethics Advisory Group. RESULTSOf 307 patients referred to the DOTS centre, 247 (80.5%) underwent all appropriate blood glucose tests and screening for current smoking status. About two thirds (64.2%) were male. Overall, 7.8% of patients had IFG, 35.5% had DM, 9.8% were current smokers and 3.6% both had DM and were current smokers (Table). The prevalence of DM and smoking was higher among the younger age groups. DISCUSSION Diabetes mellitus (DM) and tobacco smoking are independent risk factors for adverse tuberculosis (TB) treatment outcomes such as relapse, treatment failure and death. 1,2 Individuals with DM who smoke ⩾1 pack of cigarettes daily are at particularly high risk of death from TB. 3 It has been recommended that TB patients should be routinely screened for both of these risk factors and that, if present, they should be addressed to improve TB treatment outcomes. 3 India, with an annual incidence of 2.2 million TB cases, has the highest TB burden in the world. 4 Nearly 63 million people (∼8% of the adult population aged ⩾20 years) are estimated to have DM, and 120 mil...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Diabetes mellitus and smoking among tuberculosis patients in a tertiary care centre in Karnataka, India

Jali

Mahishale

Hiremath

et al. 2013

public health action

View full text Add to dashboard Cite

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“…A major difference in mean age was observed between ex-smokers and current smokers. The high mortality rate among ex-smokers probably reflected the combined effects of smoking [7][8][9][10] and age-related comorbidities [25,26]. It also remained a possibility that some of these comorbidities could have promoted the motivation for smoking cessation in the first place, and then increased the higher mortality on later follow-up.…”

Section: Discussionmentioning

confidence: 99%

Smoking adversely affects treatment response, outcome and relapse in tuberculosis

Leung¹,

Yew

Chan³

et al. 2014

Eur Respir J

142

144

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The impact of smoking on tuberculosis outcome was evaluated in a territory-wide treatment programme.16 345 consecutive patients undergoing chemotherapy for active tuberculosis in government chest clinics in Hong Kong from 2001 to 2003 were followed up prospectively for 2 years for treatment outcome and subsequently tracked through the territory-wide tuberculosis notification registry for relapse until the end of 2012.Smoking was associated with more extensive lung disease, lung cavitation and positive sputum smear and culture at the baseline. In both current smokers and ex-smokers, sputum smears and cultures were significantly more likely to remain positive after 2 months of treatment. Both categories of smokers were significantly less likely to achieve cure or treatment completion within 2 years. Overall, 16.7% of unsuccessful treatment outcomes were attributable to smoking, with the key contributor being default in current smokers and death in ex-smokers. Among successful treatment completers, there was a clear gradient (hazard ratios of 1.00, 1.33 and 1.63) of relapse risk from never-smokers to ex-smokers and current smokers, with an overall population attributable risk of 19.4% (current smokers: 12.2%; ex-smokers: 7.2%).Smoking adversely affects baseline disease severity, bacteriological response, treatment outcome and relapse in tuberculosis. Smoking cessation likely reduces relapse and secondary transmission. @ERSpublications Smoking adversely affects treatment response in TB. Smoking cessation reduces relapse and secondary transmission.

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“…[36] The relationship between DM and other co-factors that enhance TB risk are emerging (e.g. DM plus smoking) and are likely to become a common theme as additional studies are conducted [37]. …”

Section: Impact Of Dm On Progression To Tbmentioning

confidence: 99%

Impact of diabetes on the natural history of tuberculosis

Restrepo¹,

Schlesinger²

2014

Diabetes Research and Clinical Practice

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Tuberculosis (TB) is the number one bacterial killer worldwide and the current increase in type 2 diabetes mellitus patients (DM), particularly in countries where TB is also endemic, has led to the re-emerging importance of DM2 as a risk factor for TB. There is an urgent need to implement strategies for TB prevention among the millions of DM patients exposed to Mycobacterium tuberculosis (Mtb) worldwide, but knowledge is limited on how and when DM2 alters the natural history of this infection. In this review we summarize the current epidemiological, clinical and immunologic studies on TB and DM and discuss the clinical and public health implications of these findings. Specifically, we evaluate the mechanisms by which DM patients have a higher risk of Mtb infection and TB development, present with signs and symptoms indicative of a more infectious TB infection, and are more likely to have adverse TB treatment outcomes, including death. Emphasis is placed on type 2 DM given its higher prevalence in contemporary times, but the underlying role of hyperglycemia and of type 1 DM is also discussed.

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Impact of Diabetes and Smoking on Mortality in Tuberculosis

Cited by 79 publications

References 19 publications

Diabetes mellitus and smoking among tuberculosis patients in a tertiary care centre in Karnataka, India

Diabetes mellitus and smoking among tuberculosis patients in a tertiary care centre in Karnataka, India

Smoking adversely affects treatment response, outcome and relapse in tuberculosis

Impact of diabetes on the natural history of tuberculosis

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