Tuberculosis screening among persons with diabetes mellitus in Pune, India

Abstract

BackgroundDiabetes mellitus (DM) increases tuberculosis (TB) risk, and there is increasing concern over the public health implications of the convergence of these two epidemics. Screening for TB among people with DM is now recommended in India.MethodsPeople with DM seeking care at a large public sector tertiary care hospital clinic in Pune, India, were screened for TB from June 2015 to May 2016. All consenting people with DM were screened for TB at each clinic visit using a five-item, WHO-recommended questionnaire and those with TB symptoms and/or risk factors were tested for active TB using sputum smear microscopty, Xpert® MTB/RIF and TB culture. Categorical data and continuous variables were summarized using descriptive statistics. The x 2 test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively.ResultsAmong 630 adults approached for screening, median age was 60 (interquartile range (IQR), 57–64) years and 350 (56%) were females. Median hemoglobin A1c (HbA1c) was 8.7% (IQR, 6.7–9.9) and 444 (70.5%) were poorly controlled DM (HbA1c > 7). Forty-four (7%) had prior history of TB but the proportion with TB risk factors at screening was low (<5%). While 18% of participants reported any TB symptoms, none of these patients were diagnosed with culture confirmed TB.ConclusionsOur study failed to yield any active TB cases using a WHO-recommended questionnaire among people with DM. High TB risk populations among people with DM must be identified if TB screening is to be feasible in settings such as India where the DM epidemic continues to rise.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2483-9) contains supplementary material, which is available to authorized users.

Protocol for establishing an Adaptive Diseases control Expert Programme in Tanzania (ADEPT) for integrating care of communicable and non-communicable diseases using tuberculosis and diabetes as a case study

“…The algorithms for active TB will be applied as described elsewhere. 40 41 …”

Diabetes Mellitus and Tuberculosis Treatment Outcomes in Pune, India

“…Tuberculosis (TB) has emerged as the most fatal infectious disease worldwide [ 1 ], and the burden of diabetes mellitus (DM) has risen steeply in low- and middle-income countries (LMICs) [ 2–4 ]. India contributes the world’s largest TB burden (>2.7 million cases in 2019) [ 1 , 5 , 6 ] and among the largest burdens of DM (77 million adults) [ 3 , 4 , 6 ]. Convergence of the TB and DM epidemics in India may impede global TB control efforts [ 7 ], as it is well accepted that DM increases the risk of TB disease [ 8–10 ].…”

Screening for prevalence of current TB disease and latent TB infection in type 2 diabetes mellitus patients attending a diabetic clinic in an Indian tertiary care hospital

“…[16] S. Kumpatlaetal [17], screened 7083 patient of DM for TB and found that only 50(0.7%) patients had current or Past TB, which was substantially lower than what we found (5.3%). Another study by Mave et al which screened 630 patients in a public sector tertiary care hospital failed to yield any active TB case, using a WHO-recommended questionnaire among people with DM [18].A thorough screening by a Pulmonary physician, experienced in TB management could at least partly explain the higher yield in our study. There has been few attempts to…”