Outcome of Tuberculosis Treatment in Patients with Diabetes Mellitus Treated in the Revised National Tuberculosis Control Programme in Malappuram District, Kerala, India

Abstract

SettingsKerala State, India has reported the greatest dual burden of Tuberculosis (TB) and Diabetes Mellitus (DM). Malappuram district in Kerala has monitored and recorded DM status and its control from 2010 under Revised National Tuberculosis Control Program (RNTCP).ObjectivesTo assess, under programme conditions, comprehensiveness of recording DM status among TB cases and the TB treatment outcomes among DM patients (disaggregated by glycemic control) and compare with-non DM patients.DesignThis retrospective record review included 3,116TB patients from April 2010 to September 2011.DM was defined as per international guidelines and TB treatment outcomes were categorized as favourable(cured and treatment completed) and unfavourable(death, default, failure and transfer out). Relative Risk (RR) and 95% confidence intervals(CI) were calculated to assess the risk of unfavourable outcomes.ResultsDM status was recorded in 90% of TB cases and 667 (24%) had DM. 17% of DM patients and 23% of patients with unknown DM status had unfavourable outcomes but this difference was not statistically significant. Unadjusted RR for poor glycemic control or unknown control status for unfavourable outcome were (2.00; 95% CI 0.97–4.13) and (2.14; 95% CI 1.11–4.13).ConclusionThis study could not confirm an adverse association between DM or its control during treatment and the course of response to TB treatment.DM screening in TB cases and recording of DM care needs to be improved to enable more conclusive evidence.

Prevalence and Associated Factors of Diabetes Mellitus among Tuberculosis Patients in South-Eastern Amhara Region, Ethiopia: A Cross Sectional Study

“…The overall prevalence of HIV (20.0%) is higher than the DM prevalence (8.3%) observed in the study. The finding is in accordance with the study done in Gondar-Ethiopia [ 18 ] but in contrast to the study result reported from Malappuram-India [ 39 ]. This might be due to the high prevalence of HIV in the study area.…”

“…Similar to studies done in Malappuram-India [ 39 ], Tamil Nadu–India and Trivandrum–Kerela India [ 29 , 32 ], the prevalence of PTB among patients in the TBDM group was higher than TBNDM group. This might be related to defects in immune functions and decrease capacity of alveolar macrophage to eliminate mycobacterial infection in DM patients [ 3 – 4 , 9 , 40 ].…”

Glycated hemoglobin screening identifies patients admitted for retreatment of tuberculosis at risk for diabetes in Tanzania

“…However, half of all retreatment patients had prediabetes or diabetes, which was not the case for patients admitted with an initial episode of TB or MDR-TB. The diabetes co-prevalence among our population contrasts with the far higher proportions found by HgbA1c screening in studies from Southeast Asia, where the community burden of diabetes is greater [8,17], but demonstrates the importance of performing such local investigation before adopting a widespread policy.…”

The effect of diabetes control status on treatment response in pulmonary tuberculosis: a prospective study

“…However, human studies have not been able to confirm this finding. Two retrospective studies failed to find a negative association between the status of DM control during treatment and treatment response 23 31. However, a prospective study from Peru reported that the hazard rate of culture conversion among those with documented DM control was 2.2 (95% CI 1.1 to 4.1) compared with unrecognised or uncontrolled-DM.…”