Impact of Diabetes Mellitus on Treatment Outcomes of Patients with Active Tuberculosis

Abstract

Diabetes mellitus (DM) is an emerging chronic health condition of developed and developing countries. We conducted a retrospective cohort study of patients with active, culture-confirmed tuberculosis (TB) in Maryland to determine the impact of DM on TB treatment outcomes. Of 297 TB patients, 42 (14%) had DM. Patients with diabetes had 2.0 times higher odds of death than patients without diabetes (95% confidence interval [CI] 0.74-5.2, P = 0.18). Adjusting for human immunodeficiency virus (HIV), age, weight, and foreign birth, the odds of death were 6.5 times higher in patients with diabetes than patients without diabetes (95% CI 1.1-38.0, P = 0.039). In pulmonary TB patients, time to sputum culture conversion was longer in patients with diabetes than patients without diabetes (median 49 versus 39 days, P = 0.09). Two-month culture conversion proportions were similar (70% and 69%). Treatment failure occurred in 4.1% of patients without diabetes and 6.7% of patients with diabetes (P = 0.51). In conclusion, DM was a risk factor for death in Maryland TB patients. There was a trend toward increased time to culture conversion; two-month culture conversion proportions, however, were similar.

Glycemic Control and Rate of Sputum Conversion in Diabetic Patients with Pulmonary Tuberculosis

“…Magee et al found no difference in culture conversion between patients in Georgia with MDR-TB + DM and patients with MDR-TB (adjusted hazard ratio [aHR] 0.95, 95% CI 0.71-1.28 [12]. Similar results have been reported in studies conducted in Morocco [13], the United States [14], India [15], Fiji [16] and in a multinational study that included MDR-TB patients from Peru, Estonia, Russia and the Philippines [17].…”

“…The bacteriological conversion has been reported to be slower in patients with DM in comparison to that of non-diabetic patients in some reports [2][3][4], and uncontrolled DM (HbA1c ≥ 7) has been reported as a significant risk factor for positive sputum culture after two months [5]. Other reports, however, do not show DM to be an independent risk factor associated with increased time to sputum conversion [6] or any relation between DM and sputum conversion rate at the end of the 2nd month [7,8].…”

Do que morrem os pacientes com tuberculose: causas múltiplas de morte de uma coorte de casos notificados e uma proposta de investigação de causas presumíveis

“…Esse fato pode ocorrer pelo possível agravamento das doenças do aparelho circulatório pela TB 19 . Apesar de reconhecida a associação entre TB e diabetes, pelo agravamento da TB por este agravo ou vice-versa 20,21 , não se observou relação na análise aqui realizada. Dessa forma, a formulação de uma estratégia de controle específica para essa comorbidade é necessária no país.…”

Preditores dos desfechos do tratamento da tuberculose

“…There is a benefit in starting it early (15 vs. 45 days) (20) in patients with CD4 cell counts < 50 cells/ mm 3 . Another relevant problem is the toxicity of concomitant medications that prevents the use of ART.…”