Sputum smear conversion and treatment outcomes for tuberculosis patients with and without diabetes in Fiji

Abstract

Fiji is a low tuberculosis (TB) burden country, with a TB incidence rate of 24 cases per 100 000 population and a high treatment success rate of 90% (2012 data). 1 However, diabetes mellitus (DM) is very common in Fiji, and its prevalence is thought to be increasing. The STEPwise approach to Surveillance (STEPs) study conducted in 2002 reported a population prevalence of 16% for DM. 2 A more recent estimate, using a different methodology, gave a DM prevalence among adults in Fiji of 10.9%, with impaired glucose tolerance in a further 11.0%. 3 This remarkably high prevalence of DM is a matter of concern for TB control in Fiji. Published data from other settings have concluded that people with DM have a significantly increased risk of developing TB and worse treatment outcomes, with a higher risk of mortality and treatment failure during anti-tuberculosis treatment than among patients without DM. [4][5][6] In response to this evidence, the Fiji National Tuberculosis Programme (NTP) introduced random blood glucose (RBG) testing to screen for DM in all registered TB patients in 2011. 7 A recent local study reported DM in 14% of TB patients in Fiji. 8 It has been noted by local clinical and public health staff that sputum smear-positive TB patients with DM take longer to convert to smear-negative than TB patients without DM, and that they thus require longer periods of hospitalisation. However, this observation has not been verified empirically, and there are no published data from Fiji reporting sputum smear conversion or treatment response in TB patients with and without DM.In the present study, we aimed to evaluate treatment outcomes and sputum smear conversion in TB patients with DM and compare these indicators in TB patients without DM. METHODS Study designThis was a retrospective descriptive study using routinely collected data from the TB register and in-patient folders from three TB treatment hospitals in Fiji. SettingFiji is an island nation, located in the Pacific Ocean, classified as an upper middle-income economy. 9 It comprises 332 islands, of which 110 are inhabited. The population of 837 231 comprises 56.8% i-Taukei (indigenous Fijians) and 37.5% Fijians of Indian descent; the remaining 5.7% are from other ethnic backgrounds. 10 The Fiji NTP is largely funded by the government, and TB diagnosis and treatment are provided free of charge. Three government hospitals provide TB services for the entire country; the private sector is not involved in TB control. All patients diagnosed with TB are registered as TB cases and treated at one of the three TB treatment centres. The majority of TB patients are admitted for the 2-month intensive phase of treatment, during which they receive anti-tuberculosis treatment and clinical follow-up. Clinical evaluation on admission routinely includes a full medical history and RBG screening if the patient is not known to have DM. If RBG is 6.1 mmol/l, fasting blood glucose (FBG) is tested. If the FBG is 7 mmol/l, 8 patients are diagnosed as having DM and referred to a ph...

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].…”

Prevalence, Predictors and Treatment Outcome of Type 2 Diabetes among Newly Diagnosed Sputum Positive Pulmonary Tuberculosis Patients in Western Cameroon

“…This result is comparable to the result reported in Fiji [31], in Ethiopia [32] and those reported by Kelly Dooley in 2009 [33] but different from the reported study in China [34] in Texas-Mexico [35], Taiwan [36], Maharashtra-India [37], Saudi Arabia [38], and Turkey [39] where sputum conversion among TBDM patient groups were lower. The good sputum conversions observed in both patient groups in our study may be related to good treatment adherence among patients.…”

Slow radiological improvement and persistent low-grade inflammation after chemotherapy in tuberculosis patients with type 2 diabetes

“…Previously, it has been described that TB-DM co-morbidity could result in higher susceptibility to TB [1,42], more severe clinical symptoms, and slower responses to anti-TB treatment including delayed sputum-culture conversion [6,7,[44][45][46]. However, a few other studies reported no differences in sputum conversion rates or nal treatment outcome between TB and TB-DM patients after anti-TB therapy [9,10]. In the present study, sputum or culture conversion was not delayed in TB-DM patients compared to TB patients, and accordingly treatment outcome did not differ between the groups.…”

“…Several studies have demonstrated that at the end of 2 months intensive phase anti-TB treatment diabetic TB patients are sputum positive more often than TB patients without DM [4][5][6][7][8] . However in contrast, other studies failed to detect differences between TB-DM and TB patients in sputum smear or culture conversion [9,10]. TB-DM co-morbidity at the time of TB diagnosis has frequently been associated with a hyper-in ammatory cytokine pro le [11,12], and recently a plasma biomarker assay demonstrated that this systemic in ammatory state persisted in TB-DM patients throughout effective anti-TB treatment [13].…”