Screening patients with tuberculosis for diabetes mellitus in Ampara, Sri Lanka

Rajapakshe, Wasantha; Isaakidis, Petros; Sagili, Karuna D.; Kumar, Ajay M. V.; Samaraweera, Sudath; Pallewatta, N.; Jayakody, Wasantha; Nissanka, Ayoma

doi:10.5588/pha.15.0006

Cited by 14 publications

(10 citation statements)

References 7 publications

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“…Our results revealed that the prevalence of DM was significantly higher among PTB patients than extra-pulmonary TB (EPTB) patients, which is consistent with other studies performed in India8,11,16, Ethiopia10, and Sri Lanka12. The association between PTB and DM might be related to the temporary elevation of blood sugar due to infection with TB.…”

Section: Discussionsupporting

confidence: 91%

“…The NNS in the current study ranged between 27 (for patients aged ≥ 40 years) and 483 (for TB patients younger than 30 years). This finding is much higher than what was reported in other studies in India, Ethiopia, Sri Lanka, Kenya, Peru, Nigeria and China 8,10,12,14,17–19…”

Section: Discussioncontrasting

confidence: 66%

“…Regarding the association between gender and the prevalence of DM among TB patients, the current study showed a significant higher prevalence of DM among females even after adjusting for other confounder factors. There is no consensus about sex and the prevalence of DM as some studies have reported a higher prevalence among males8,11, 12, while other studies have reported the reverse10 while many researches did not find any association 13–16…”

Section: Discussionmentioning

confidence: 99%

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Screening for diabetes among tuberculosis patients: a nationwide population-based study in Egypt

Gadallah¹,

Amin²,

Fawzy³

et al. 2018

Afr H. Sci.

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BackgroundThe prevalence of type 2 diabetes mellitus (DM) is increasing rapidly in Egypt and considered one of the major health problems in the Eastern Mediterranean region.ObjectivesTo measure the prevalence of diabetes and detect the undiagnosed cases of diabetes mellitus among patient with tuberculosis.MethodsStudy Design: Nationwide population-based study. To diagnose DM among TB patients, we used a fasting blood sugar level of ≥ 126 mg/dl and a post-prandial blood glucose test result of ≥ 200 mg/dl.ResultsScreening for DM among 1435 TB patients' with no history of DM detected 30 new cases of DM, with a case detection rate of 2.09%. The highest screening yields were among TB patients aged ≥ 40 years, females and those with pulmonary TB. The number needed to screen (NNS) TB patients for detecting one new case of DM was 48 while the lowest values were for older age (NNS=27) and females (NNS=29).ConclusionOlder age and being females and those with pulmonary type of TB were more prone to the double burden of TB and DM. Identifying cases with double burden of diseases will improve the proper management of both diseases and prevent complications.

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Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

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Screening for diabetes among tuberculosis patients: a nationwide population-based study in Egypt

Gadallah¹,

Amin²,

Fawzy³

et al. 2018

Afr H. Sci.

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“…In a cross-sectional study conducted in West Africa, participants displayed a 5% IFG and a 1.9% DM rate, which is comparable with the current study despite differing inclusion criteria [ 67 ]. A retrospective study performed in Sri Lanka found 7.1% pre-existing DM among their study sample, as well as 20% IFG and 2% DM rates (although lower fasting glucose cut-off values were used) [ 68 ]. These raised levels could also be attributed to the “stress/transient hyperglycaemia” phenomenon [ 18 , 19 , 69 , 70 ], as well as the pro-inflammatory response [ 12 , 13 ] and medication effects [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

The association between tuberculosis and the development of insulin resistance in adults with pulmonary tuberculosis in the Western sub-district of the Cape Metropole region, South Africa: a combined cross-sectional, cohort study

et al. 2017

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BackgroundThe existence of a bi-directional relationship between tuberculosis (TB) and insulin resistance (IR)/diabetes has been alluded to in literature. Although diabetes has been linked to increased tuberculosis risk, the relationship between tuberculosis as a causative factor for IR remains unclear. The study aimed to determine if an association existed between tuberculosis and IR development in adults with newly diagnosed pulmonary tuberculosis at baseline. It was additionally aimed to document changes in IR status during TB follow-up periods.MethodsThis cross-sectional study evaluated ambulatory participants at baseline for IR prevalence via anthropometry, biochemistry and diagnostic IR tests [homeostasis model assessment-IR (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI)]. A prospective cohort sub-section study was additionally performed on approximately half of the baseline study population, who were followed-up at two and five months whilst on tuberculosis treatment. Summary statistics, correlation co-efficients and appropriate analysis of variance were used to describe and analyse data. Participants were excluded if they presented with other forms of tuberculosis, were HIV-positive, obese or had any pre-disposing IR conditions such as diabetes or metabolic syndrome.ResultsFifty-nine participants were included from August 2013 until December 2014 (33.95 ± 12.02 years old; 81.4% male). IR prevalence was 25.4% at baseline, determined by a calculated HOMA-IR cut-off point of 2.477. Patients with IR were younger (p = 0.04). Although the difference between IR levels in participants between baseline and follow-up was not significant, a decrease was observed over time. The majority of participants (61.0%) presented with a normal BMI at baseline. Mean baseline values of fasting glucose were within normal ranges (4.82 ± 0.80 mmol/L), whereas increased mean CRP levels (60.18 ± 50.92 mg/L) and decreased mean HDL-cholesterol levels (males: 0.94 ± 0.88 mmol/L; females: 1.14 ± 0.88 mmol/L) were found.ConclusionsThe study found an association between tuberculosis and IR development in newly diagnosed pulmonary tuberculosis patients. Although not significant, IR levels decreased over time, which could be indicative of a clinical improvement. A high prevalence of IR amongst young tuberculosis patients therefore highlights the need for early identification in order to facilitate a reversal of IR and prevent possible IR-related complications.

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“…31 A model of opportunistic screening for diabetes in patients with tuberculosis is being evaluated in Sri Lanka. 37 Examples of successful public-private partnerships for non-communicable disease healthcare in the region are limited. Pakistan's National Action Plan for Non-communicable Diseases is one such model, 38 which involved a tripartite collaboration with Heartfile, a not for profit organisation, in formulation of policy and implementation in partnership with the government and WHO.…”

Section: Health In South Asiamentioning

confidence: 99%

Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions

Misra

Tandon

Ebrahim

et al. 2017

BMJ

113

109

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Screening patients with tuberculosis for diabetes mellitus in Ampara, Sri Lanka

Cited by 14 publications

References 7 publications

Screening for diabetes among tuberculosis patients: a nationwide population-based study in Egypt

Screening for diabetes among tuberculosis patients: a nationwide population-based study in Egypt

The association between tuberculosis and the development of insulin resistance in adults with pulmonary tuberculosis in the Western sub-district of the Cape Metropole region, South Africa: a combined cross-sectional, cohort study

Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions

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