Tuberculosis and diabetes: current state and future perspectives

Pizzol, Damiano; Gennaro, Francesco Di; Chhaganlal, Kajal; Fabrizio, Claudia; Monno, Laura; Putoto, Giovanni; Saracino, Annalisa

doi:10.1111/tmi.12704

Cited by 60 publications

(62 citation statements)

References 106 publications

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“…Secondly, we utilised FBG for diagnosis; FBG testing has low sensitivity and may fail to detect some persons with DM. However, FBG has been recommended as the initial DM screening test in resource-limited settings5. The HbA1c has also been recently recommended for the diagnosis of DM among TB patients; however, it is limited by being expensive, cumbersome to perform and inappropriate for screening individuals within routine general health services17.…”

Section: Discussionmentioning

confidence: 99%

“…Systematic reviews have shown that the overall risk of TB in persons with DM is three times higher than in the general population345. In addition, persons with dual TB-DM disease have worse TB treatment outcomes with increased delays to sputum culture conversion, higher risk of relapse, death and drug resistance567. Conversely, TB and its treatment can impair glycaemic control – impacting the clinical management of DM58.…”

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confidence: 99%

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Screening for diabetes mellitus among tuberculosis patients in Southern Nigeria: a multi-centre implementation study under programme settings

Ekeke¹,

Ukwaja

Chukwu³

et al. 2017

Sci Rep

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Implementation studies are recommended to assess the feasibility and effectiveness of programmes. In Nigeria, little is known about the burden of diabetes mellitus (DM) among tuberculosis (TB) patients. The objective of this study was to determine screening efficacy, prevalence of DM and determinants of DM among TB patients. We report on a multi-centre implementation study carried-out in 13 health facilities in six States of Southern Nigeria. All newly diagnosed TB patients registered from March to October 2015 were screened for DM using current World Health Organisation guidelines. Overall, 2094 TB patients were evaluated, 196 (9.4%) were found to have DM. The prevalence of newly diagnosed DM was 5.5% (115/2094). DM prevalence varied according to age group; occurring in 2.2% of patients aged ≤ 25 years and 16.9% in patients aged (56–65) years. The additional yield of DM was 59% while the number needed to screen to detect a new case of DM was 18. Factors associated with DM were; age >40 years (aOR2.8, CI 2.1–3.9), rural residence (aOR2.3, 1.6–3.2), private health facility care (aOR2.0, 1.4–2.7), and having an occupation that engages in vigorous activity (aOR0.6, 0.4–0.9). The burden of DM among TB patients is high. Prioritization of DM screening for TB patients is indicated.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Screening for diabetes mellitus among tuberculosis patients in Southern Nigeria: a multi-centre implementation study under programme settings

Ekeke¹,

Ukwaja

Chukwu³

et al. 2017

Sci Rep

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“…Diabetes mellitus (DM) is an important co-morbidity in patients with tuberculosis (TB) because it can increase the risk of active TB [3, 4], have severe clinical manifestations, and cause worse outcomes [5, 6]. DM can also cause dysregulation of the immune system, resulting in altered levels of cytokines and chemokines [7, 8].…”

Section: Introductionmentioning

confidence: 99%

Impact of diabetes mellitus on indeterminate results of the QuantiFERON TB Gold In-Tube test: A propensity score matching analysis

Shin

Kim

et al. 2017

PLoS ONE

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BackgroundThe sensitivity of interferon-gamma release assays (IGRAs) in the detection of Mycobacterium tuberculosis infection could be affected by conditions of immune dysregulation. For this reason, diabetes mellitus (DM) may increase the frequency of indeterminate results of IGRAs. However, there have been inconsistent reports of role of DM on indeterminate IGRA results.MethodsWe retrospectively reviewed all patients who underwent QuantiFERON-TB Gold In-Tube testing (QFT-GIT) at Chonnam National University Hospital. We collected the clinical and laboratory data of these patients.ResultsOf all 3,391 subjects, 1,265 (37.3%) had a positive QFT-GIT result, 266 (7.8%) had an indeterminate result, and 1,860 (54.9%) had a negative result. The mean age was 54.8 ± 18.1 years and 55.0% of the patients were male. There were 512 (15.1%) patients with DM. Multivariable analysis revealed that systemic corticosteroid use, tuberculosis, lymphocytopenia, low serum albumin, and high serum C-reactive protein (CRP) levels were significantly associated with indeterminate QFT-GIT results. However, DM was not associated with indeterminate QFT-GIT results (adjusted odds ratio, 0.98; 95% confidence interval, 0.69–1.41; P = 0.939). After propensity score matching, DM was not associated with indeterminate results of QFT-GIT.ConclusionIn this large cohort study, DM does not affect the incidence of indeterminate results of QFT-GIT.

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“…As the global DM burden shifts down the socioeconomic ladder, DM and TB comorbidity will increase, exacerbating each other in a bidirectional relationship . Diabetes mellitus weakens the immune system through impairing both innate and adaptive immune functions and leads to a greater risk of poor TB outcomes including worse clinical presentation, more symptoms, increased transmission, relapse, treatment failure, and death . A seminal systematic review published in 2008 by Jeon and Murray found that DM causes a 3‐fold lifetime increase in TB risk (relative risk = 3.11) .…”

Section: Introductionmentioning

confidence: 99%

Coprevalence of type 2 diabetes mellitus and tuberculosis in low‐income and middle‐income countries: A systematic review

McMurry

Mendenhall

Rajendrakumar

et al. 2018

Diabetes Metabolism Res

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Increasing coprevalence of diabetes mellitus (DM) and tuberculosis (TB) in low-income and middle-income countries (LMICs) indicates a rising threat to the decades of progress made against TB and requires global attention. This systematic review provides a summary of type 2 diabetes and tuberculosis coprevalence in various LMICs. We searched PubMed, Ovid Medline, Embase, and PsychINFO databases for studies that provided estimates of TB-DM coprevalence in LMICs published between 1990 and 2016. Studies that were non-English and exclusively conducted in multidrug resistant-tuberculosis or type 1 diabetes and inpatient settings were excluded. We reviewed 84 studies from 31 countries. There were huge diversity of study designs and diagnostic methods used to estimate coprevalence, and this precluded pooling of the results. Most studies (n = 78) were from small, localized settings. The DM prevalence among TB patients in various LMICs varied from 1.8% to 45%, with the majority (n = 44) between 10% and 30%. The TB prevalence among people with DM ranged from 0.1% to 6.0% with most studies (n = 9) reporting prevalences less than 2%. Coprevalence of TB-DM was higher than general population prevalence of either diseases in these countries. This study underscores the need for intervention and more focused research on TB DM bidirectional screening programs in low-income and middle-income countries as well as integrated chronic disease management.

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Tuberculosis and diabetes: current state and future perspectives

Abstract: This review outlines the association between tuberculosis and diabetes, focusing on epidemiology, physiopathology, clinical aspects, diagnosis and treatment, and evaluates future perspectives, with particular attention to developing countries.

Cited by 60 publications

References 106 publications

Screening for diabetes mellitus among tuberculosis patients in Southern Nigeria: a multi-centre implementation study under programme settings

Screening for diabetes mellitus among tuberculosis patients in Southern Nigeria: a multi-centre implementation study under programme settings

Impact of diabetes mellitus on indeterminate results of the QuantiFERON TB Gold In-Tube test: A propensity score matching analysis

Coprevalence of type 2 diabetes mellitus and tuberculosis in low‐income and middle‐income countries: A systematic review

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