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...