The Influence of Diabetes, Glycemic Control, and Diabetes-Related Comorbidities on Pulmonary Tuberculosis

Abstract

BackgroundTo assess the influence of diabetes mellitus (DM), glycemic control, and diabetes-related comorbidities on manifestations and outcome of treatment of pulmonary tuberculosis (TB).Methodology/Principal FindingsCulture positive pulmonary TB patients notified to health authorities in three hospitals in Taiwan from 2005–2010 were investigated. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C) and diabetic patients were categorized into 3 groups: HbA1C<7%, HbA1C 7–9%, HbA1C>9%. 1,473 (705 with DM and 768 without DM) patients were enrolled. Of the 705 diabetic patients, 82 (11.6%) had pretreatment HbA1C<7%, 152 (21.6%) 7%–9%, 276 (39.2%) >9%, and 195 (27.7%) had no information of HbA1C. The proportions of patients with any symptom, cough, hemoptysis, tiredness and weight loss were all highest in diabetic patients with HbA1C>9%. In multivariate analysis adjusted for age, sex, smoking, and drug resistance, diabetic patients with HbA1C>9% (adjOR 3.55, 95% CI 2.40–5.25) and HbA1C 7–9% (adjOR 1.62, 95% CI 1.07–2.44) were significantly more likely to be smear positive as compared with non-diabetic patients, but not those with HbA1C<7% (adjOR 1.16, 95% CI 0.70–1.92). The influence of DM on outcome of TB treatment was not proportionately related to HbA1C, but mainly mediated through diabetes-related comorbidities. Patients with diabetes-related comorbidities had an increased risk of unfavorable outcome (adjOR 3.38, 95% CI 2.19–5.22, p<0.001) and one year mortality (adjOR 2.80, 95% CI 1.89–4.16). However, diabetes was not associated with amplification of resistance to isoniazid (p = 0.363) or to rifampicin (p = 0.344).Conclusions/SignificancePoor glycemic control is associated with poor TB treatment outcome and improved glycemic control may reduce the influence of diabetes on TB.

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.…”

The effect size of type 2 diabetes mellitus on tuberculosis drug resistance and adverse treatment outcomes

“…This delay in DR testing is due to funding limitations, and it is not just a particular situation in Mexico, but for most of the developing countries where TB and T2DM are prevalent. Thus, we find higher number of cases of MDR-TB among TB-T2DM patients, as reported in some studies (Bashar, Alcabes, Rom, & Condos, 2001;Chang et al, 2011;Chiang et al, 2015;Garcia-Garcia et al, 2001), but we cannot distinguish primary from secondary drug resistance cases in TB-T2DM patients. This is a serious limitation that calls for changes.…”

Did diabetes mellitus affect treatment outcome in drug-resistant tuberculosis patients in Pakistan from 2010 to 2014?

“…[11][12][13][14] However, studies in South Korea, Taiwan and Brazil have reported an association of DM with unfavourable outcomes. [7][8][9] These studies also report that unfavourable outcomes were significantly associated with poor glycaemic controls and other comorbidities caused by DM, such as chronic renal diseases, cardiovascular diseases and cerebrovascular diseases in patients with DM. 9 Our results show a higher death rate in patients with DM than in those without DM (20.8% vs. 16.6%).…”

“…[7][8][9] These studies also report that unfavourable outcomes were significantly associated with poor glycaemic controls and other comorbidities caused by DM, such as chronic renal diseases, cardiovascular diseases and cerebrovascular diseases in patients with DM. 9 Our results show a higher death rate in patients with DM than in those without DM (20.8% vs. 16.6%). As cause of death is not recorded in the surveillance system, it is unknown whether the high mortality is due to the increased severity of TB in patients with DM or the presence of other factors.…”

“…Various studies conducted in different countries have suggested that there is a significantly higher risk of adverse outcomes among patients with DR-TB and DM, [7][8][9][10] although other studies reported finding no association between the two. [11][12][13][14] Recent studies in Pakistan have shown more unfavourable outcomes among DS-TB patients with DM; 15,16 however, we could not find any relevant study examining the effect of DM on treatment outcomes among DR-TB patients in Pakistan.…”