The epidemiology of tuberculosis-associated hyperglycemia in individuals newly screened for type 2 diabetes mellitus: systematic review and meta-analysis

Abstract

Background There is scarce evidence that tuberculosis (TB) can cause diabetes in those not previously known to be diabetic. Whilst the World Health Organization (WHO) recommends screening for Diabetes Mellitus (DM) at the onset of TB treatment, nevertheless, it remains to be elucidated which patients with TB-associated hyperglycemia are at higher risk for developing DM and stand to benefit from a more regular follow-up. This review aims to firstly quantify the reduction of newly detected hyperglycemia burden in TB patients who are on treatment over time; secondly, determine the burden of TB-associated hyperglycemia after follow-up, and thirdly, synthesize literature on risk factors for unresolved TB-associated hyperglycemia in previously undiagnosed individuals. Methods We searched PUBMED, EMBASE, SCOPUS, and Global Health for articles on TB-associated hyperglycemia up to September 30th, 2019. Search terms included Tuberculosis and hyperglycemia/DM, and insulin resistance. We appraised studies, extracted data, and conducted a meta-analysis to assess the change of the burden of hyperglycemia in prospective studies. The review is registered in the PROSPERO database (CRD42019118173). Results Eleven studies were included in the meta-analysis yielding a total of 677 (27,3%) of patients with newly detected hyperglycemia at baseline. The mean quality score of eligible studies using the Newcastle-Ottawa Quality Assessment Scale was 7.1 out of 9 (range 6-9). The pooled unresolved new cases of hyperglycemia at the end of follow up was 50% (95% CI: 36–64%) and the total pooled burden of hyperglycemia at 3–6 months of follow up was 11% (95% CI: 7–16%), with both estimates displaying a high heterogeneity, which remained significant after performing a sub-analysis by DM diagnostic method and 3 months of follow up. As only 2 studies explored risk factors for unresolved hyperglycemia, no meta-analysis was performed on risk factors. Conclusion Our meta-analysis showed that although in half of the patients with newly observed hyperglycemia at baseline, it remained unresolved at a follow-up of 3 to 6 months, the total burden of hyperglycemia is slightly above 10%, 3 months after initiating TB treatment. Studies are warranted to assess whether risk factors including HIV positivity, smoking, and extensive pulmonary TB disease put patients at higher risk for DM.

Prevalence of cardiovascular risk factors in active tuberculosis in Africa: a systematic review and meta-analysis

“…Therefore, transient hyperglycaemia could spuriously increase the prevalence of DM. Nonetheless, hyperglycaemia does not resolve at follow-up in 50% of people with TB and hyperglycaemia at baseline 84 . More studies are needed to determine whether transient hyperglycaemia in TB heralds new onset DM or predicts future risk for DM.…”

Hepatitis B Virus and Tuberculosis Are Associated with Increased Noncommunicable Disease Risk among Treatment-Naïve People with HIV: Opportunities for Prevention, Early Detection and Management of Comorbidities in Sierra Leone

“…The association between TB and DM is well known; however, data are conflicting on the direction of the relationship. Diabetics are 1.5 to 3 times more likely to develop active TB [ 63 , 64 ]. Conversely, a meta-analysis by Menon et al [ 65 ] showed that up to 50% of people diagnosed with TB had hyperglycemia at baseline, which remained unresolved in over 10% of cases even after 6 months of effective anti-TB treatment.…”

Association between prior tuberculosis disease and dysglycemia within an HIV-endemic, rural South African population

“…Participants with active TB, defined as a positive Xpert MTB/ RIF, positive Mycobacterium tuberculosis culture, or individuals currently taking TB therapy at the time of study enrollment, were excluded from this analysis. We excluded those with active TB because active disease may result in stress hyperglycemia [19], and our work focuses on the effect of prior TB on the risk of future dysglycemia. We also excluded participants with active cancer or autoimmune diseases and those who reported taking anti-epileptic or glucocorticoid medications because these conditions and therapies can affect hemoglobin A1c.…”