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Workneh MH, Bjune GA, Yimer SA. Prevalence and Associated Factors of Diabetes Mellitus among Tuberculosis Patients in South-Eastern Amhara Region, Ethiopia: A Cross Sectional Study. PLoS One 2016; 11:e0147621. [PMID: 26808967 PMCID: PMC4726615 DOI: 10.1371/journal.pone.0147621] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/06/2016] [Indexed: 12/31/2022] Open
Abstract
Background The association between diabetes mellitus (DM) and tuberculosis (TB) is re-emerging worldwide. Recently, the prevalence of DM is increasing in resource poor countries where TB is of high burden. The objective of the current study was to determine the prevalence and analyze associated factors of TB and DM comorbidity in South-Eastern Amhara Region, Ethiopia. Methods This was a facility based cross-sectional study. All newly diagnosed TB patients attending selected health facilities in the study area were consecutively screened for DM. DM was diagnosed based on the World Health Organization diagnostic criteria. A pre-tested semi-structured questionnaire was used to collect socio-demographic, lifestyles and clinical data. Logistic regression analysis was performed to identify factors associated with TB and DM comorbidity. Result Among a total of 1314 patients who participated in the study, the prevalence of DM was estimated at 109 (8.3%). Being female [odds ratio (OR) 1.70; 95% confidence interval (CI) (1.10–2.62)], patients age [41–64 years (OR 3.35; 95% CI (2.01–5.57), 65–89 years (OR 3.18; 95% CI (1.52–6.64)], being a pulmonary TB case [(OR 1.69; 95% CI 1.09–2.63)] and having a family history of DM [(OR 4.54; 95% CI (2.36–8.73)] were associated factors identified with TB and DM comorbidity. Conclusion The prevalence of DM among TB patients in South-Eastern Amahra Region is high. Routine screening of TB patients for DM is recommended in the study area.
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Affiliation(s)
- Mahteme Haile Workneh
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
- * E-mail:
| | - Gunnar Aksel Bjune
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Solomon Abebe Yimer
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
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Umanah T, Ncayiyana J, Padanilam X, Nyasulu PS. Treatment outcomes in multidrug resistant tuberculosis-human immunodeficiency virus Co-infected patients on anti-retroviral therapy at Sizwe Tropical Disease Hospital Johannesburg, South Africa. BMC Infect Dis 2015; 15:478. [PMID: 26511616 PMCID: PMC4625623 DOI: 10.1186/s12879-015-1214-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 10/14/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Multidrug resistant-tuberculosis (MDR-TB) is a threat to global tuberculosis control which is worsened by human immune-deficiency virus (HIV) co-infection. There is however paucity of data on the effects of antiretroviral treatment (ART) before or after starting MDR-TB treatment. This study determined predictors of mortality and treatment failure among HIV co-infected MDR-TB patients on ART. METHODS A retrospective medical record review of 1200 HIV co-infected MDR-TB patients admitted at Sizwe Tropical Disease Hospital, Johannesburg from 2007 to 2010 was performed. Chi-square test was used to determine treatment outcomes in HIV co-infected MDR-TB patients on ART. Multivariable logistic regression and Poisson models were used to determine predictors of mortality and treatment failure respectively. RESULTS Mortality was higher (21.8% vs. 15.4%) among patients who started ART before initiating MDR-TB treatment compared with patients initiated on ART after commencing MDR-TB treatment (p = 0.013). Factors significantly associated with mortality included: the use of ART before starting MDR-TB treatment (OR 1.65, 95% CI 1.02-2.73), severely-underweight (OR 3.71, 95% CI 1.89-7.29) and underweight (OR 2.35, 95% CI 1.30-4.26), cavities on chest x-rays at baseline (OR 1.76, 95% CI 1.08-2.94), presence of other opportunistic infections (OR 1.80, 95% CI 1.10-2.94) and presence of other co-morbidities (OR 2.26, 95% CI 1.20-4.21). Factors predicting failure were severe anaemia (IRR (OR 4.72, 95% CI 1.47-15), other co-morbidities (OR 2.39, 95% CI 1.05-5.43) and modified individualised regimen at baseline (OR 2.15, 95% CI 0.98-4.71). CONCLUSIONS High mortality among patients already on ART before initiating MDR-TB treatment is a worrisome development. Management of adverse-events, opportunistic infections and co-morbidities in these patients is important if the protective benefits of being on ART are to be maximized. There is the need to intensify intervention programmes targeted at early identification of MDR-TB, treatment initiation, drug monitoring and increasing adherence among HIV co-infected MDR-TB patients.
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Affiliation(s)
- Teye Umanah
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Jabulani Ncayiyana
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Xavier Padanilam
- Sizwe Tropical Disease Hospital, Gauteng Department of Health, Sandringham, Johannesburg.
| | - Peter S Nyasulu
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
- Department of Public Health, School of Health Sciences, Monash University, 144 Peter Road, Rumsuig, Johannesburg, South Africa.
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Oren E, Alatorre-Izaguirre G, Vargas-Villarreal J, Moreno-Treviño MG, Garcialuna-Martinez J, Gonzalez-Salazar F. Interferon Gamma-Based Detection of Latent Tuberculosis Infection in the Border States of Nuevo Leon and Tamaulipas, Mexico. Front Public Health 2015; 3:220. [PMID: 26484340 PMCID: PMC4588115 DOI: 10.3389/fpubh.2015.00220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 09/17/2015] [Indexed: 01/26/2023] Open
Abstract
Nearly one-third of the world’s population is infected with latent tuberculosis (LTBI). Tuberculosis (TB) rates in the border states are higher than national rates in both the US and Mexico, with the border accounting for 30% of total registered TB cases in both countries. However, LTBI rates in the general population in Mexican border states are unknown. In this region, LTBI is diagnosed using the tuberculin skin test (TST). New methods of detection more specific than TST have been developed, although there is currently no gold standard for LTBI detection. Our objective is to demonstrate utility of the Quantiferon TB gold In-Tube (QFT-GIT) test compared with the TST to detect LTBI among border populations. This is an observational, cross-sectional study carried out in border areas of the states of Nuevo Leon and Tamaulipas, Mexico. Participants (n = 210) provided a TST and blood sample for the QFT-GIT. Kappa coefficients assessed the agreement between TST and QFT-GIT. Participant characteristics were compared using Fisher exact tests. Thirty-eight percent of participants were diagnosed with LTBI by QFT-GIT. The proportion of LTBI detected using QFT-GIT was almost double [38% (79/210)] that found by TST [19% (39/210)] (P < 0.001). Concordance between TST and QFT-GIT was low (kappa = 0.37). We recommend further studies utilizing the QFT-GIT test to detect LTBI among border populations.
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Affiliation(s)
- Eyal Oren
- Division of Epidemiology and Biostatistics, University of Arizona , Tucson, AZ , USA
| | | | | | | | | | - Francisco Gonzalez-Salazar
- Health Division, Basic Sciences, University of Monterrey , San Pedro Garza Garcia , Mexico ; Northeast Biomedical Research, Mexican Social Security Institute , Monterrey , Mexico
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Jali MV, Mahishale VK, Hiremath MB, Satyanarayana S, Kumar AMV, Nagaraja SB, Isaakidis P. Diabetes mellitus and smoking among tuberculosis patients in a tertiary care centre in Karnataka, India. Public Health Action 2015; 3:S51-3. [PMID: 26393071 DOI: 10.5588/pha.13.0031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/13/2013] [Indexed: 11/10/2022] Open
Abstract
Diabetes mellitus (DM) and smoking are risk factors for adverse outcomes in the treatment of tuberculosis (TB). In a tertiary care hospital at Belgaum in the South Indian State of Karnataka, all TB patients aged ≥18 years consecutively diagnosed from February to September 2012 were evaluated for DM and smoking. Of 307 TB patients, 35.5% were found to have DM, 9.8% were current smokers, and 3.6% had DM and were also smokers. Measures to assess and address both these factors need to be taken into account during TB treatment.
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Affiliation(s)
- M V Jali
- KLES Diabetes Centre, KLES Dr Prabhakar Kore Hospital & Medical Research Centre, Belgaum, Karnataka, India
| | - V K Mahishale
- Department of Pulmonary Medicine, KLES Dr Prabhakar Kore Hospital & Medical Research Centre, Belgaum, Karnataka, India
| | - M B Hiremath
- KLES Diabetes Centre, KLES Dr Prabhakar Kore Hospital & Medical Research Centre, Belgaum, Karnataka, India
| | - S Satyanarayana
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Office, New Delhi, India
| | - S B Nagaraja
- Employees State Insurance Corporation (ESIC) Post Graduate Institute of Medical Science and Research and Model Hospital, Rajaji Nagar, Bangalore, India
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Maitra A, Danquah CA, Scotti F, Howard TK, Kamil TK, Bhakta S. Tackling tuberculosis: Insights from an international TB Summit in London. Virulence 2015; 6:661-72. [PMID: 26151309 PMCID: PMC4720247 DOI: 10.1080/21505594.2015.1060396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Tuberculosis (TB) poses a grave predicament to the world as it is not merely a scientific challenge but a socio-economic burden as well. A prime cause of mortality in human due to an infectious disease; the malady and its cause, Mycobacterium tuberculosis have remained an enigma with many questions that remain unanswered. The ability of the pathogen to survive and switch between varied physiological states necessitates a protracted therapeutic regimen that exerts an excessive strain on low-resource countries. To complicate things further, there has been a significant rise of antimicrobial resistance. Existing control measures, including treatment regimens have remained fairly uniform globally for at least half a century and require reinvention. Overcoming the societal and scientific challenges requires an increase in dialog to identify key regions that need attention and effective partners with whom successful collaborations can be fostered. In this report, we explore the discussions held at the International TB Summit 2015 hosted by EuroSciCon, which served as an excellent platform for researchers to share their recent findings. Ground-breaking results require outreach to affect policy design, governance and control of the disease. Hence, we feel it is important that meetings such as these reach a wider, global audience.
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Affiliation(s)
- Arundhati Maitra
- a Mycobacteria Research Laboratory ; Institute of Structural and Molecular Biology; Birkbeck ; University of London , Malet Street, Bloomsbury, London WC1E 7HX , United Kingdom
| | - Cynthia A Danquah
- a Mycobacteria Research Laboratory ; Institute of Structural and Molecular Biology; Birkbeck ; University of London , Malet Street, Bloomsbury, London WC1E 7HX , United Kingdom
| | - Francesca Scotti
- a Mycobacteria Research Laboratory ; Institute of Structural and Molecular Biology; Birkbeck ; University of London , Malet Street, Bloomsbury, London WC1E 7HX , United Kingdom
| | - Tracey K Howard
- a Mycobacteria Research Laboratory ; Institute of Structural and Molecular Biology; Birkbeck ; University of London , Malet Street, Bloomsbury, London WC1E 7HX , United Kingdom
| | - Tengku K Kamil
- a Mycobacteria Research Laboratory ; Institute of Structural and Molecular Biology; Birkbeck ; University of London , Malet Street, Bloomsbury, London WC1E 7HX , United Kingdom
| | - Sanjib Bhakta
- a Mycobacteria Research Laboratory ; Institute of Structural and Molecular Biology; Birkbeck ; University of London , Malet Street, Bloomsbury, London WC1E 7HX , United Kingdom
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Delgado-Sánchez G, García-García L, Castellanos-Joya M, Cruz-Hervert P, Ferreyra-Reyes L, Ferreira-Guerrero E, Hernández A, Ortega-Baeza VM, Montero-Campos R, Sulca JA, Martínez-Olivares MDL, Mongua-Rodríguez N, Baez-Saldaña R, González-Roldán JF, López-Gatell H, Ponce-de-León A, Sifuentes-Osornio J, Jiménez-Corona ME. Association of Pulmonary Tuberculosis and Diabetes in Mexico: Analysis of the National Tuberculosis Registry 2000-2012. PLoS One 2015; 10:e0129312. [PMID: 26075393 PMCID: PMC4468212 DOI: 10.1371/journal.pone.0129312] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 05/07/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) remains a public health problem in Mexico while the incidence of diabetes mellitus type 2 (DM) has increased rapidly in recent years. OBJECTIVE To describe the trends of incidence rates of pulmonary TB associated with DM and not associated with DM and to compare the results of treatment outcomes in patients with and without DM. MATERIALS AND METHODS We analysed the National Tuberculosis Registry from 2000 to 2012 including patients with pulmonary TB among individuals older than 20 years of age. The association between DM and treatment failure was analysed using logistic regression, accounting for clustering due to regional distribution. RESULTS In Mexico from 2000 to 2012, the incidence rates of pulmonary TB associated to DM increased by 82.64%, (p<0.001) in contrast to rates of pulmonary TB rate without DM, which decreased by 26.77%, (p<0.001). Patients with a prior diagnosis of DM had a greater likelihood of failing treatment (adjusted odds ratio, 1.34 (1.11-1.61) p<0.002) compared with patients who did not have DM. There was statistical evidence of interaction between DM and sex. The odds of treatment failure were increased in both sexes. CONCLUSION Our data suggest that the growing DM epidemic has an impact on the rates of pulmonary TB. In addition, patients who suffer from both diseases have a greater probability of treatment failure.
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Affiliation(s)
- Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Lourdes García-García
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- * E-mail:
| | - Martín Castellanos-Joya
- Dirección de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Andrés Hernández
- Departamento de Epidemiología, Instituto Nacional de Enfermedades Respiratorias, México, Distrito Federal, México
| | - Victor Manuel Ortega-Baeza
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - José Antonio Sulca
- Dirección de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Ma. de Lourdes Martínez-Olivares
- Dirección de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Norma Mongua-Rodríguez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Renata Baez-Saldaña
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Jesús Felipe González-Roldán
- Dirección General, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Hugo López-Gatell
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Alfredo Ponce-de-León
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - José Sifuentes-Osornio
- Dirección Médica, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - María Eugenia Jiménez-Corona
- Dirección General Adjunta de Epidemiología, Dirección General de Epidemiología, México, Distrito Federal, México
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Bridson T, Matthiesson A, Owens L, Govan B, Norton R, Ketheesan N. Diabetes: A Contributor to Tuberculosis in Tropical Australia. Am J Trop Med Hyg 2015; 93:547-8. [PMID: 26055738 DOI: 10.4269/ajtmh.15-0264] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 04/30/2015] [Indexed: 11/07/2022] Open
Abstract
In countries with a high-burden of tuberculosis (TB), it has been well established that there is an increased incidence of TB among patients with diabetes. However, in countries with a low burden of TB there are conflicting reports. This study aimed to determine if diabetes was associated with TB in patients admitted to a teaching hospital in tropical Australia. A 20-year retrospective study found patients with comorbid diabetes were seven times overrepresented in the TB patient population when compared with the general population. This study demonstrates a strong association between TB and diabetes regardless of TB endemicity.
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Affiliation(s)
- Tahnee Bridson
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; Townsville Hospital, Townsville, Queensland, Australia
| | - Anthony Matthiesson
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; Townsville Hospital, Townsville, Queensland, Australia
| | - Leigh Owens
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; Townsville Hospital, Townsville, Queensland, Australia
| | - Brenda Govan
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; Townsville Hospital, Townsville, Queensland, Australia
| | - Robert Norton
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; Townsville Hospital, Townsville, Queensland, Australia
| | - Natkunam Ketheesan
- Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia; Townsville Hospital, Townsville, Queensland, Australia
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Effects on type 2 diabetes complicated with pulmonary tuberculosis: regiment of insulin, isoniazid, rifampicin, pyrazinamide and ethambutol versus the regiment plus Qi-boosting and Yin-nourishing decoction of Traditional Chinese Medicine. J TRADIT CHIN MED 2015; 35:260-5. [DOI: 10.1016/s0254-6272(15)30095-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Martínez-Aguilar G, Serrano CJ, Castañeda-Delgado JE, Macías-Segura N, Hernández-Delgadillo N, Enciso-Moreno L, García de Lira Y, Valenzuela-Méndez E, Gándara-Jasso B, Correa-Chacón J, Bastián-Hernández Y, Rodríguez-Morán M, Guerrero-Romero F, Enciso-Moreno JA. Associated Risk Factors for Latent Tuberculosis Infection in Subjects with Diabetes. Arch Med Res 2015; 46:221-7. [DOI: 10.1016/j.arcmed.2015.03.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/30/2015] [Indexed: 11/24/2022]
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Pérez-Navarro LM, Fuentes-Domínguez FJ, Zenteno-Cuevas R. Type 2 diabetes mellitus and its influence in the development of multidrug resistance tuberculosis in patients from southeastern Mexico. J Diabetes Complications 2015; 29:77-82. [PMID: 25303784 DOI: 10.1016/j.jdiacomp.2014.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 08/19/2014] [Accepted: 09/10/2014] [Indexed: 11/26/2022]
Abstract
AIMS To determine the factors associated with the presence of pulmonary tuberculosis in patients with type 2 diabetes mellitus and the effect in the development of drug and multi-drug resistance, in a population with tuberculosis from the southeast of Mexico. METHODS This is a case-control study including 409 individuals, 146 with the binomial tuberculosis-type 2 diabetes mellitus and 263 individuals with tuberculosis. Demographic, epidemiological and outcome variables were collected. Risks were calculated. RESULTS The factors associated with the presence of type 2 diabetes mellitus were age ≥35years, (OR=9.7; CI: 5.2-17.8), previous contact with a person infected with tuberculosis (OR=1.7; CI: 1.1-3.1). Body mass index ≥25 kg/m(2) (OR=2.2; CI: 1.1-4.3), and inherited family history of diabetes (OR=5.4; CI: 3.2-9.2). It was also found that patients with tuberculosis-type 2 diabetes mellitus presented a 4.7-fold (CI: 1.4-11.3) and 3.5-fold (CI: 1.1-11.1) higher risk of developing drug- and multidrug resistance tuberculosis, respectively. By last, individuals with tuberculosis-type 2 diabetes had a 2.3-fold (CI: 1.5-4.1) greater chance of persisting as tuberculosis-positive by the second month of treatment, delaying the resolution of the tuberculosis infection. CONCLUSIONS Type 2 diabetes exerts a strong influence on the presentation and evolution of tuberculosis within the analyzed population and displays remarkable particularities, necessitating the development of dedicated tuberculosis-diabetes surveillance systems that consider the particular epidemiological characteristics of the population affected.
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Affiliation(s)
- Lucia Monserrat Pérez-Navarro
- Public Health Institute, University of Veracruz, Veracruz, Mexico; Doctoral program in Biomedical Sciences, Biomedical Research Center, University of Veracruz, Veracruz, México.
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Restrepo BI, Schlesinger LS. Impact of diabetes on the natural history of tuberculosis. Diabetes Res Clin Pract 2014; 106:191-9. [PMID: 25082309 PMCID: PMC4260985 DOI: 10.1016/j.diabres.2014.06.011] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) is the number one bacterial killer worldwide and the current increase in type 2 diabetes mellitus patients (DM), particularly in countries where TB is also endemic, has led to the re-emerging importance of DM2 as a risk factor for TB. There is an urgent need to implement strategies for TB prevention among the millions of DM patients exposed to Mycobacterium tuberculosis (Mtb) worldwide, but knowledge is limited on how and when DM2 alters the natural history of this infection. In this review we summarize the current epidemiological, clinical and immunologic studies on TB and DM and discuss the clinical and public health implications of these findings. Specifically, we evaluate the mechanisms by which DM patients have a higher risk of Mtb infection and TB development, present with signs and symptoms indicative of a more infectious TB infection, and are more likely to have adverse TB treatment outcomes, including death. Emphasis is placed on type 2 DM given its higher prevalence in contemporary times, but the underlying role of hyperglycemia and of type 1 DM is also discussed.
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Affiliation(s)
- Blanca I Restrepo
- UTHealth Houston, School of Public Health at Brownsville, 80 Fort Brown, Brownsville, TX 78520, United States.
| | - Larry S Schlesinger
- Center for Microbial Interface Biology, Department of Microbial Infection and Immunity, The Ohio State University, 460W 12th Avenue, Columbus, OH 43210, United States
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Badawi A, Sayegh S, Sallam M, Sadoun E, Al-Thani M, Alam MW, Arora P. The global relationship between the prevalence of diabetes mellitus and incidence of tuberculosis: 2000-2012. Glob J Health Sci 2014; 7:183-91. [PMID: 25716376 PMCID: PMC4796449 DOI: 10.5539/gjhs.v7n2p183] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2014] [Accepted: 06/26/2014] [Indexed: 11/12/2022] Open
Abstract
Background: The dual burden of tuberculosis (TB) and diabetes mellitus (DM) has increased over the past decade with DM prevalence increasing in countries already afflicted with a high burden of TB. The coexistence of the two conditions presents a serious threat to global public health. Objective: The present study examines the global relationship between the prevalence of DM and the incidence of TB to evaluate their coexistence worldwide and their contribution to one another. Methods: This is an ecological longitudinal study covering the period between years 2000 to 2012. We utilized data from the WHO and World Bank sources and International Diabetes Federation to estimate prevalence of DM (%) and the incidence of TB (per 100,000). Measures of central tendency and dispersion as well as the harmonic mean and linear regression were used for different WHO regions. The association between DM prevalence and TB incidence was examined by quartile of DM prevalence. Results: The worldwide average (±S.D.) prevalence of DM within the study period was 6.6±3.8% whereas TB incidence was 135.0±190.5 per 100,000. DM prevalence was highest in the Eastern Mediterranean (8.3±4.1) and West Pacific (8.2±5.6) regions and lowest in the Africa (3.5±2.6). TB incidence was highest in Africa (313.1±275.9 per 100,000) and South-East Asia (216.7±124.9) and lowest in the European (46.5±68.6) and American (47.2±52.9) regions. Only countries with high DM prevalence (>7.6%) showed a significant positive association with TB incidence (r=0.17, p=0.013). Conclusion: A positive association between DM and TB may exist in some – but not all – world regions, a dual burden that necessitates identifying the nature of this coexistence to assist in developing public health approaches that curb their rising burden.
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Affiliation(s)
- Alaa Badawi
- Office of Biotechnology, Genomics and Population Health, Public Health Agency of Canada Toronto, ON Canada.
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Fisher-Hoch SP. Worldwide increase in diabetes: implications for tuberculosis control. Res Rep Trop Med 2014; 5:35-44. [PMID: 32669890 PMCID: PMC7337143 DOI: 10.2147/rrtm.s45082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/23/2014] [Indexed: 01/13/2023] Open
Abstract
Diabetes presents a greater threat to global tuberculosis (TB) control than previously appreciated, with risk of reversing the achievements of several decades. An estimated 382 million people worldwide currently have diabetes, half of whom are undiagnosed. Most live in low- and middle-income countries alongside many of the two billion individuals infected with TB. Though the frequency of TB in type 1 diabetes was known for centuries, only recently have we observed the tripling of TB in type 2 diabetes, most significantly in high-burden TB populations such as in Peru, Russia, and the People's Republic of China. In India diabetes is estimated to have increased TB cases by 46% between 1998 and 2008. Diabetes is a greater long-term threat to TB control than human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) since ten-fold more people are affected by diabetes than HIV/AIDS in larger geographic areas. Diabetes in TB increases drug resistance, treatment failure, and mortality, and may increase the spread of drug-resistant strains. Delayed or missed diagnosis fuels transmission of TB and hinders control of diabetes. Tailored treatment for diabetes patients requires well-designed clinical trials. The World Health Organization (WHO) framework for care and control of diabetes and TB needs improved screening strategies. Determination of how best to establish bi-directional screening is hampered by lack of affordable and reliable methods. Recommendations include education of health care providers, patients, and communities. Structured diabetes programs with registries and effective follow-up could be modeled on and communicate with existing TB programs. Vital research should address new diagnostic tools, lowering cost and evaluation of intervention strategies, as well as better understanding of the impaired immune responses that make diabetes patients more susceptible to TB leading to targeted therapies. Solutions will require the combination of good science, good decision-making, adequate funding, and political will.
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Affiliation(s)
- Susan P Fisher-Hoch
- Division of Epidemiology, Human Genetics and Environmental Science, University of Texas School of Public Health, Brownsville Campus, Brownsville, TX, USA
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64
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Jørgensen ME, Faurholt-Jepsen D. Is there an effect of glucose lowering treatment on incidence and prognosis of tuberculosis? A systematic review. Curr Diab Rep 2014; 14:505. [PMID: 24806518 DOI: 10.1007/s11892-014-0505-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The association between diabetes and incidence of tuberculosis is well established, and observational studies have shown poor treatment outcome in tuberculosis related to hyperglycemia. The WHO recommends screening for diabetes among all patients with tuberculosis and optimized glycemic control aiming at improving tuberculosis outcome. However, no intervention studies support this notion. Patients with tuberculosis are often vulnerable with high degree of comorbidity, and, therefore, at high risk of adverse effects of intensive glucose control. Controlled intervention studies of the effect of glucose lowering treatment on tuberculosis outcomes are clearly warranted to justify screening for- and tight control of diabetes.
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65
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Ogbera AO, Kapur A, Chinenye S, Fasanmade O, Uloko A, Odeyemi K. Undiagnosed diabetes mellitus in tuberculosis: A Lagos report. Indian J Endocrinol Metab 2014; 18:475-479. [PMID: 25143901 PMCID: PMC4138900 DOI: 10.4103/2230-8210.137488] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) and diabetes mellitus (DM) are two diseases that are individually relatively common and of immense public health significance globally. There is a growing awareness on a global scale on the possible relationship between TB and DM. Nigeria is a country with a high burden of TB and an increasing incidence of DM. We set out to determine the frequency of occurrence of undiagnosed DM in TB patients. MATERIALS AND METHODS This was an observational study that was carried out in TB patients recruited from 56 DOT centers in Lagos, Nigeria. The main objective of the study was to determine the disease burden of DM in patients with TB by comparing the frequency of occurrence of DM in TB to the occurrence of DM in people without TB. Screening was carried out by staff-nurses and community health workers-of these DOT facilities who all had capacity building on the detection of DM at the start of the project. RESULTS Of 4000 TB patients, a total of 480 (12.3%) had DM. Of the pool of DM patients, newly diagnosed cases of DM were 310 (8%) in number and previously known persons with DM were 170 (4.3%). The newly diagnosed cases of DM made up 64% of the cases of DM. In the study population without TB, a total of 112 (5.6%) had DM. The number of newly diagnosed cases of DM were 40 in number and these made up 2% of this study group. The number of persons who were already known to have DM was 72 and these made up 3.6% of the study population. New cases of DM made up 44% of the total number of cases of DM detected in persons without TB. CONCLUSION The detection rates of DM in patients with TB are higher than in persons without TB. Given the fact that DM may negatively impact TB treatment, we suggest that routine screening be carried out for TB in persons with DM.
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Affiliation(s)
| | | | - Sunday Chinenye
- Department of Medicine, College of Medicine, University of Port Harcourt, Rivers State, Nigeria
| | | | - Andrew Uloko
- Department of Medicine, Kano State University, Kano, Nigeria
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66
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Impact of diabetes on clinical presentation and treatment outcome of pulmonary tuberculosis in Beijing. Epidemiol Infect 2014; 143:150-6. [PMID: 24717600 DOI: 10.1017/s095026881400079x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Diabetes mellitus (DM) is currently known to be one of the risk factors for pulmonary tuberculosis (PTB) and the proportion of DM in PTB is rising along with the increased prevalence of DM in countries with high PTB burden. This study was designed to explore the impact of DM on clinical presentation and treatment outcome of PTB in China. In an urban setting in Beijing, 1126 PTB patients, 30·6% with positive sputum smear, registered in two PTB dispensaries from January 2010 to December 2011 were screened for DM and were followed up prospectively during PTB treatment. DM was observed in 16·2% of patients with PTB. PTB with DM appeared to be associated with older age and a higher proportion of re-treatment. On presentation, DM was associated with more severe PTB signs with higher proportions of smear positivity [odds ratio (OR) 2·533, 95% confidence interval (CI) 1·779-3·606], cavity (OR 2·253, 95% CI 1·549-3·276) and more symptoms (OR 1·779, 95% CI 1·176-2·690). DM was also associated with non-TB deaths (OR 5·580, 95% CI 2·182-14·270, P < 0·001) and treatment failure (OR 6·696, 95% CI 2·019-22·200, P = 0·002). In Beijing, the findings of this study underlined the need to perform early bi-directional screening programmes and explore the underlying mechanism for different treatment outcomes for PTB with DM.
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67
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Magee MJ, Foote M, Maggio DM, Howards PP, Narayan KMV, Blumberg HM, Ray SM, Kempker RR. Diabetes mellitus and risk of all-cause mortality among patients with tuberculosis in the state of Georgia, 2009-2012. Ann Epidemiol 2014; 24:369-75. [PMID: 24613196 DOI: 10.1016/j.annepidem.2014.01.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 01/14/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To estimate the association between diabetes mellitus (DM) and all-cause mortality during tuberculosis (TB) treatment. METHODS From 2009 to 2012, a retrospective cohort study among reported TB cases in Georgia was conducted. Patients aged 16 years or older were classified by DM and human immunodeficiency virus (HIV) status at the time of TB diagnosis and followed during TB treatment to assess mortality. Hazard ratios were used to estimate the association between DM and death. RESULTS Among 1325 patients with TB disease, 151 (11.4%) had DM, 147 (11.1%) were HIV-infected, and seven (0.5%) had both DM and HIV. Patients with TB-DM were more likely to have cavitary lung disease compared with those with TB alone (51.0% vs. 34.7%) and those with TB-HIV were more likely to have military/disseminated disease (12.9% vs. 3.4%) and resistance to rifampin or isoniazid (21.8% vs. 9.0%) compared with those without HIV infection (P < .05). In multivariable analysis, DM was not associated with death during TB treatment (hazard ratio, 1.22; 95% confidence interval, 0.70-2.12) or any death (adjusted odds ratio, 1.05; 95% confidence interval, 0.60-1.84). CONCLUSIONS Among TB patients in Georgia, the prevalence of comorbid DM and coinfection with HIV was nearly identical. In adjusted models, TB patients with DM did not have increased risk of all-cause mortality.
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Affiliation(s)
- Matthew J Magee
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
| | - Mary Foote
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - David M Maggio
- Division of Health Protection, Georgia Department of Public Health, Atlanta, GA
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - K M Venkat Narayan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Henry M Blumberg
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Susan M Ray
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Russell R Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
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68
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Restrepo BI, Schlesinger LS. Host-pathogen interactions in tuberculosis patients with type 2 diabetes mellitus. Tuberculosis (Edinb) 2013; 93 Suppl:S10-4. [PMID: 24388642 PMCID: PMC4019931 DOI: 10.1016/s1472-9792(13)70004-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Tuberculosis (TB) is known to be fueled by HIV as well as social and economic factors. With progression of the diabetes mellitus (DM) pandemic in countries where TB is also endemic, focus is increasing on the potential links between DM and TB. Despite the magnitude of the DM-TB association worldwide, it is striking how little we know about the underlying biology that promotes this association which is a major concern to public health. In this review we summarize current findings regarding the alterations in the innate and adaptive immune responses of DM patients to Mycobacterium tuberculosis (Mtb). Current findings suggest underperforming innate immunity followed by a hyper-reactive cellular response to Mtb, but the contribution of these altered responses to TB susceptibility or to the more adverse clinical outcomes of TB patients with DM remains unclear. Elucidating the basic mechanisms underlying the higher susceptibility of DM patients to TB should lead to a strategy for stratification of the millions of DM patients worldwide into those with the highest TB risk for targeted TB prevention.
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Affiliation(s)
- Blanca I Restrepo
- UTHealth Houston, School of Public Health at Brownsville, 80 Fort Brown, Brownsville, Texas 78520, USA.
| | - Larry S Schlesinger
- Center for Microbial Interface Biology and Department of Microbial Infection and Immunity, 460W 12th Ave, The Ohio State University, Columbus, Ohio 43210, USA
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69
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Epidemiologic investigation of tuberculosis in a Mexican population from Chihuahua State, Mexico: a pilot study. Tuberculosis (Edinb) 2013; 93 Suppl:S71-7. [DOI: 10.1016/s1472-9792(13)70014-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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70
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Kuo MC, Lin SH, Lin CH, Mao IC, Chang SJ, Hsieh MC. Type 2 diabetes: an independent risk factor for tuberculosis: a nationwide population-based study. PLoS One 2013; 8:e78924. [PMID: 24236069 PMCID: PMC3827305 DOI: 10.1371/journal.pone.0078924] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 09/17/2013] [Indexed: 11/18/2022] Open
Abstract
Objective Tuberculosis continues to be a major global health problem. We wanted to investigate whether Type 2 diabetes was a risk factor for tuberculosis in an Asian population. Methods From Taiwan’s National Health Insurance Research Database, we collected data from 31,237 female patients with type 2 diabetes and 92,642 female controls and 32,493 male patients with type 2 diabetes and 96,977 male controls. Cox proportional hazard regression was performed to evaluate independent risk factors for tuberculosis in all patients and to identify risk factors in patients with type 2 diabetes. Results During the study period, both female (standardized incidence ratio (SIR): 1.40, p<0.01) and male (SIR: 1.48, p<0.01) patients with type 2 diabetes were found to have a significantly higher rate of incident tuberculosis than the control group. Type 2 diabetes (HR:1.31, 1.23–1.39, p<0.001) was significantly associated with tuberculosis after adjusting sex, age, bronchiectasis, asthma and chronic obstructive lung disease. Conclusions Patients with type 2 diabetes have a higher risk of tuberculosis compared to control subjects after adjusting for confounding factors. The current diabetes epidemic may lead to a resurgence of tuberculosis in endemic regions. Therefore, preventive measures, including addressing the possibility that type 2 diabetes increase the individual’s susceptibility for incident TB, should be taken to further reduce the incidence of tuberculosis.
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Affiliation(s)
- Ming-Chun Kuo
- Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Sheng-Hao Lin
- Division of Chest medicine, Department of internal medicine, Changhua Christian Hospital, Changhua City, Taiwan
- Department of respiratory care, College of health sciences, Chang Jung Christian University, Tainan, Taiwan
| | - Ching-Hsiung Lin
- Division of Chest medicine, Department of internal medicine, Changhua Christian Hospital, Changhua City, Taiwan
- Taiwan School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Biomedical Sciences, National Chung Hsing University, Taichung, Taiwan
| | - I-Chieh Mao
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Shun-Jen Chang
- Department of Kinesiology, Health and Leisure Studies, National University of Kaohsiung, Kaohsiung City, Taiwan
- * E-mail: (S-JC); (M-CH)
| | - Ming-Chia Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
- * E-mail: (S-JC); (M-CH)
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71
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Fisher-Hoch SP, Mathews CE, McCormick JB. Obesity, diabetes and pneumonia: the menacing interface of non-communicable and infectious diseases. Trop Med Int Health 2013; 18:1510-9. [PMID: 24237786 DOI: 10.1111/tmi.12206] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To review current knowledge on the epidemiological, clinical and biological impact of the pandemic of obesity and diabetes on pneumonias. METHODS We conducted a literature review using PubMed and EMBASE, supplemented by various sources. Given the disparate and fragmented nature of the literature, a formal systematic review was not possible. RESULTS In 2008, globally 10% of men and 14% of women were obese and an estimated 371 million had diabetes; half undiagnosed and many obese. Numbers are rising rapidly in low- and middle-income countries where the majority reside, but reliable data are lacking. The most frequent pneumonias in obesity and diabetes are tuberculosis, influenza and pneumococcal, staphylococcal and opportunistic pathogens. Diabetes impacts tuberculosis control and increases drug resistance and mortality. Mortality and morbidity from pneumococcal pneumonia and influenza are increased in obesity and diabetes. In addition to mechanical and physiological effects, there are considerable immunological abnormalities characterised by chronic, low-grade inflammation. Simultaneous up-regulation and dysregulation of both innate and adaptive immune responses impair control and killing of invading organisms. Prevention in those at risk is poorly practised, although screening for tuberculosis in diabetes is beginning in high-burden settings. CONCLUSIONS Pneumonia is a threat globally in obesity and diabetes with increased incidence and severity of disease. There is uncertainty about whether vaccines are equally effective in those with obesity and diabetes. Increased epidemiological, clinical and biological knowledge will be crucial to face this 21st century challenge.
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Affiliation(s)
- Susan P Fisher-Hoch
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, Brownsville, TX, USA
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72
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Murunga AN, Owira PMO. Diabetic ketoacidosis: an overlooked child killer in sub-Saharan Africa? Trop Med Int Health 2013; 18:1357-64. [PMID: 24112393 DOI: 10.1111/tmi.12195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The true incidence of diabetic ketoacidosis (DKA) in sub-Saharan Africa is unknown but unlike in the Western countries, DKA is also uniquely frequent among type 2 diabetes patients of African origin. Increased hyperglycaemia and hepatic ketogenesis lead to osmotic diuresis, dehydration and tissue hypoxia. Acute complications of DKA include cerebral oedema, which may be compounded by malnutrition, parasitic and microbial infections with rampant tuberculosis and HIV. Overlapping symptoms of these conditions and misdiagnosis of DKA contribute to increased morbidity and mortality. Inability of the patients to afford insulin treatment leads to poor glycemic control as some patients seek alternative treatment from traditional healers or use herbal remedies further complicating the disease process. Standard treatment guidelines for DKA currently used may not be ideal as they are adapted from those of the developed world. Children presenting with suspected DKA should be screened for comorbidities which may complicate fluid and electrolyte replacement therapy protocol. Patient rehabilitation should take into account concurrent treatment for infectious conditions to avoid possible life-threatening drug interactions. We recommend that health systems in sub-Saharan Africa leverage the Expanded Immunization Programme or TB/HIV/AIDS programmes, which are fairly well entrenched to support diabetes services.
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Affiliation(s)
- A N Murunga
- School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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73
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Jali MV, Mahishale VK, Hiremath MB. Bidirectional screening of tuberculosis patients for diabetes mellitus and diabetes patients for tuberculosis. Diabetes Metab J 2013; 37:291-5. [PMID: 23991408 PMCID: PMC3753495 DOI: 10.4093/dmj.2013.37.4.291] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 04/19/2013] [Indexed: 11/17/2022] Open
Abstract
To assess the feasibility and results of screening diabetes mellitus (DM) patients for tuberculosis (TB) and TB patients for DM within the routine health care setting. Prospective observational study carried out within the Diabetes Centre and Pulmonary Medicine Department from February 2012 to September 2012. The screening for active TB in DM and DM in TB patients is followed as per the guidelines of the Revised National Tuberculosis Control Programme and national programmes in India. Total of 307 patients diagnosed with TB during the study period. Among the TB patients 9.77% were smokers, 19.54% were known cases diabetes, and 15.96% were newly diagnosed cases of diabetes. Total of 4,118 diabetes patients were screened for TB in which 111 patients found to have TB. The strengths of this study are that we implemented screening within the routine health system. It is feasible to screen DM patients for TB resulting in high rates of TB detection.
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Affiliation(s)
| | - Vinay K. Mahishale
- Department of Pulmonary Medicine, KLES Dr Prabhakar Kore Hospital & Medical Research Centre, Belgaum, India
| | - Murigendra B. Hiremath
- KLES Diabetes Centre, Belgaum, India
- Faculty of Natural Sciences and Engineering, National Institute of Advanced Studies, Indian Institute of Science Campus, Bangalore, India
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74
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Kapur A, Harries AD. The double burden of diabetes and tuberculosis - public health implications. Diabetes Res Clin Pract 2013; 101:10-9. [PMID: 23305899 DOI: 10.1016/j.diabres.2012.12.001] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 12/10/2012] [Indexed: 01/04/2023]
Abstract
Diabetes mellitus (DM) and tuberculosis (TB) have existed for thousands of years and even now the global disease burden from DM and TB is huge. The incidence of TB is declining slowly but it still remains a big problem in many populous large low and middle income countries. On the other, hand the burden of diabetes is increasing very rapidly, particularly in the very same countries where TB is endemic. The intersecting double burden is therefore ominous particularly as several studies and systematic reviews have indicated that DM increases the risk of TB disease and results in poor treatment outcomes. To address the double burden, WHO and the International Union Against Tuberculosis and Lung Disease (The Union) in 2011 launched a collaborative framework for the care and control of diabetes and tuberculosis, to encourage collaborative research and implement bidirectional screening of the two diseases in routine settings. This review article (i) explores some of the new evidence for the association between TB and DM, (ii) discusses issues with regard to clinical presentation and outcomes, (iii) presents the evidence, challenges and strategies for bidirectional screening based on field studies to implement the framework and (iv) finally presents suggestions on how diabetes care delivery may benefit from the lessons of the TB DOTS approach and public health principles for structured care delivery.
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Affiliation(s)
- Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark.
| | - Anthony D Harries
- International Union Against Tuberculosis and Lung Diseases, Paris, France; London School of Hygiene and Tropical Medicine, London, UK
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Faurholt-Jepsen D, Range N, PrayGod G, Jeremiah K, Faurholt-Jepsen M, Aabye MG, Changalucha J, Christensen DL, Grewal HMS, Martinussen T, Krarup H, Witte DR, Andersen AB, Friis H. Diabetes is a strong predictor of mortality during tuberculosis treatment: a prospective cohort study among tuberculosis patients from Mwanza, Tanzania. Trop Med Int Health 2013; 18:822-9. [PMID: 23648145 DOI: 10.1111/tmi.12120] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Strong evidence suggests diabetes may be associated with tuberculosis (TB) and could influence TB treatment outcomes. We assessed the role of diabetes on sputum culture conversion and mortality among patients undergoing TB treatment. METHODS A total of 1250 Tanzanian TB patients were followed prospectively during TB treatment with sputum culture after 2 and 5 months. Survival status was assessed at least 1 year after initiation of treatment. At baseline, all participants underwent testing for diabetes and HIV, and the serum concentration of the acute phase reactant alpha-1 glycoprotein (AGP) was determined. RESULTS There were no differences between participants with and without diabetes regarding the proportion of positive cultures at 2 (3.8% vs. 5.8%) and 5 (1.3% vs. 0.9%) months (P > 0.46). However, among patients with a positive TB culture, relatively more patients with diabetes died before the 5-month follow-up. Within the initial 100 days of TB treatment, diabetes was associated with a fivefold increased risk of mortality (RR 5.09, 95% CI 2.36; 11.02, P < 0.001) among HIV uninfected, and a twofold increase among HIV co-infected patient (RR 2.33 95% CI 1.20; 4.53, P = 0.012), while diabetes was not associated with long-term mortality. Further adjustment with AGP did not change the estimates. CONCLUSION Diabetes considerably increases risk of early mortality during TB treatment. The effect may not be explained by increased severity of TB, but could be due to impaired TB treatment response. Research is needed to clarify the mechanism and to assess whether glycaemic control improves survival.
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Affiliation(s)
- Daniel Faurholt-Jepsen
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Frederiksberg, Denmark.
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Olayinka AO, Anthonia O, Yetunde K. Prevalence of diabetes mellitus in persons with tuberculosis in a tertiary health centre in Lagos, Nigeria. Indian J Endocrinol Metab 2013; 17:486-489. [PMID: 23869307 PMCID: PMC3712381 DOI: 10.4103/2230-8210.111646] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT In Nigeria, much has been reported on the unacceptably high disease burden of Tuberculosis (TB) and Diabetes Mellitus (DM) but not the possible co-existence of these diseases. AIM This study was conducted to document the co-existence of DM and TB in persons with established TB. SETTINGS AND DESIGN This was a cross-sectional study conducted at a Tertiary hospital's Directly Observed Therapy short course clinic in Lagos, South west, Nigeria. MATERIALS AND METHODS Three hundred and fifty one consecutive patients with TB who consented to the study participated after a written consent. Ethical approval was given by the Ethics committee of the institution. Clinical examination for documentation of anthropometric indices and biochemical evaluation for blood glucose levels were carried out. RESULTS The prevalence of DM among the patients with TB was 5.7%. About half of the diabetics were diagnosed (2.8%) at the screening. The mean age of the participants was 34.9 ± 13.21 years; the mean duration of symptoms of TB was 9.65 ± 9.49 months. Weight (kg) loss was the most predominant symptom occurring in 94% of the patients. There was no significant difference in the sputum positivity and duration of cough among patients with TB-DM and those with TB alone. CONCLUSION Diabetes is an important co-morbid feature to be sought in patients with TB. This study re-echo the need to raise awareness on screening for DM in persons with TB.
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Affiliation(s)
| | - Ogbera Anthonia
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Kuyinu Yetunde
- Department of Community Medicine and Primary Health Care, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Reis-Santos B, Locatelli R, Horta BL, Faerstein E, Sanchez MN, Riley LW, Maciel EL. Socio-demographic and clinical differences in subjects with tuberculosis with and without diabetes mellitus in Brazil--a multivariate analysis. PLoS One 2013; 8:e62604. [PMID: 23638123 PMCID: PMC3634755 DOI: 10.1371/journal.pone.0062604] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 03/23/2013] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Several studies have evaluated the relationship between diabetes mellitus (DM) and tuberculosis (TB), but the nature of this relationship is not fully understood. TB incidence may be influenced by immunosuppression from DM, but this association may be confounded by other clinical and socioeconomic factors. We aimed to assess socio-demographic and clinical differences in TB patients with and without DM. METHODS Using the Brazilian national surveillance system (SINAN), we compared 1,797 subjects with TB and DM with 29,275 subjects diagnosed with TB only in 2009. We performed multivariate analysis to identify factors associated with the presence of DM among TB patients. RESULTS Subjects with TB - DM were older; have initial positive sputum smear test (OR = 1.42, 95% CI 1.26-1.60), and were more likely to die from TB (OR = 1.44, 95% CI 1.03-2.01). They were less likely to have been institutionalized [in prison, shelter, orphanage, psychiatric hospital (OR = 0.74, 95% CI 0.60-0.93)]; developed extra pulmonary TB (OR = 0.62, 95% CI 0.51-0.75) and to return to TB treatment after abandonment (OR = 0.66, 95% CI 0.51-0.86). CONCLUSIONS Prevalence of NCD continues to rise in developing countries, especially with the rise of elderly population, the prevention and treatment of infectious diseases will be urgent. DM and TB represent a critical intersection between communicable and non-communicable diseases in these countries and the effect of DM on TB incidence and outcomes provide numerous opportunities for collaboration and management of these complex diseases in the national public health programs.
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Affiliation(s)
- Barbara Reis-Santos
- Lab-Epi UFES – Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Rodrigo Locatelli
- Lab-Epi UFES – Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Bernardo L. Horta
- Post-Graduate Programme in Epidemiology, Universidade Federal de Pelotas, Rio Grande do Sul, Brazil
| | - Eduardo Faerstein
- Post-Graduate Programme in Saúde Coletiva, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mauro N. Sanchez
- Departamento de Saúde Coletiva, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brazil
| | - Lee W. Riley
- Division of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley, California, United States of America
| | - Ethel Leonor Maciel
- Lab-Epi UFES – Laboratory of Epidemiology, Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
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Reed GW, Choi H, Lee SY, Lee M, Kim Y, Park H, Lee J, Zhan X, Kang H, Hwang S, Carroll M, Cai Y, Cho SN, Barry CE, Via LE, Kornfeld H. Impact of diabetes and smoking on mortality in tuberculosis. PLoS One 2013; 8:e58044. [PMID: 23469139 PMCID: PMC3585219 DOI: 10.1371/journal.pone.0058044] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 01/30/2013] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Diabetes mellitus is a risk factor for tuberculosis (TB) disease. There is evidence that diabetes also influences TB severity and treatment outcomes but information is incomplete and some published results have been inconsistent. METHODS A longitudinal cohort study was conducted at the National Masan Tuberculosis Hospital in the Republic of Korea. Subjects presenting with a first episode of TB or for retreatment of TB were followed from enrollment through completion of treatment. Demographic, clinical, and microbiological variables were recorded, along with assessment of outcomes. Results were compared in TB patients with and without diabetes or smoking history. Data were adjusted for gender, age, cohort, educational level and alcohol consumption. RESULTS The combined cohorts comprised 657 subjects. Diabetes was present in 25% and was associated with greater radiographic severity and with recurrent or relapsed TB. Diabetes and cigarette smoking independently increased the risk of death in the first 12 months after enrollment. Estimating the combined impact of diabetes and smoking yielded a hazard ratio of 5.78. Only 20% of diabetic subjects were non-smokers; 54% smoked ≥1 pack daily. In this cohort, the impact of diabetes on mortality was greater in patients younger than 50 years, compared to older patients. CONCLUSIONS In this cohort of Korean patients, diabetes exacerbated the severity of TB disease. Diabetic subjects who smoked ≥1 pack of cigarettes daily were at particularly high risk of death from TB. Strategies to improve TB outcomes could productively focus resources for patient education and TB prevention on the vulnerable population of younger diabetics, particularly those who also smoke.
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Affiliation(s)
- George W. Reed
- Department of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Hongjo Choi
- International Tuberculosis Research Center, Changwon, Republic of Korea
| | - So Young Lee
- International Tuberculosis Research Center, Changwon, Republic of Korea
| | - Myungsun Lee
- International Tuberculosis Research Center, Changwon, Republic of Korea
| | - Youngran Kim
- International Tuberculosis Research Center, Changwon, Republic of Korea
| | - Hyemi Park
- International Tuberculosis Research Center, Changwon, Republic of Korea
| | - Jongseok Lee
- International Tuberculosis Research Center, Changwon, Republic of Korea
| | - Xin Zhan
- Information Services Department, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Hyeungseok Kang
- National Masan Tuberculosis Hospital, Changwon, Republic of Korea
| | - SooHee Hwang
- National Masan Tuberculosis Hospital, Changwon, Republic of Korea
| | - Matthew Carroll
- Tuberculosis Research Section, Laboratory of Clinical Infectious Disease, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Ying Cai
- Tuberculosis Research Section, Laboratory of Clinical Infectious Disease, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Sang-Nae Cho
- International Tuberculosis Research Center, Changwon, Republic of Korea
- Department of Microbiology, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Clifton E. Barry
- Tuberculosis Research Section, Laboratory of Clinical Infectious Disease, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Laura E. Via
- Tuberculosis Research Section, Laboratory of Clinical Infectious Disease, National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, United States of America
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
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Magee MJ, Bloss E, Shin SS, Contreras C, Huaman HA, Ticona JC, Bayona J, Bonilla C, Yagui M, Jave O, Cegielski JP. Clinical characteristics, drug resistance, and treatment outcomes among tuberculosis patients with diabetes in Peru. Int J Infect Dis 2013; 17:e404-12. [PMID: 23434400 DOI: 10.1016/j.ijid.2012.12.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/10/2012] [Accepted: 12/14/2012] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Diabetes is a risk factor for active tuberculosis (TB). Data are limited regarding the association between diabetes and TB drug resistance and treatment outcomes. We examined characteristics of TB patients with and without diabetes in a Peruvian cohort at high risk for drug-resistant TB. Among TB patients with diabetes (TB-DM), we studied the association between diabetes clinical/management characteristics and TB drug resistance and treatment outcomes. METHODS During 2005-2008, adults with suspected TB with respiratory symptoms in Lima, Peru, who received rapid drug susceptibility testing (DST), were prospectively enrolled and followed during treatment. Bivariate and Kaplan-Meier analyses were used to examine the relationships of diabetes characteristics with drug-resistant TB and TB outcomes. RESULTS Of 1671 adult TB patients enrolled, 186 (11.1%) had diabetes. TB-DM patients were significantly more likely than TB patients without diabetes to be older, have had no previous TB treatment, and to have a body mass index (BMI) >18.5 kg/m(2) (p<0.05). In patients without and with previous TB treatment, the prevalence of multidrug-resistant TB was 23% and 26%, respectively, among patients without diabetes, and 12% and 28%, respectively, among TB-DM patients. Among 149 TB-DM patients with DST results, 104 (69.8%) had drug-susceptible TB and 45 (30.2%) had drug-resistant TB, of whom 29 had multidrug-resistant TB. There was no association between diabetes characteristics and drug-resistant TB. Of 136 TB-DM patients with outcome information, 107 (78.7%) had a favorable TB outcome; active diabetes management was associated with a favorable outcome. CONCLUSIONS Diabetes was common in a cohort of TB patients at high risk for drug-resistant TB. Despite prevalent multidrug-resistant TB among TB-DM patients, the majority had a favorable TB treatment outcome.
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Affiliation(s)
- M J Magee
- Rollins School of Public Health, Emory University, Atlanta, USA
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81
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Jiménez-Corona ME, Cruz-Hervert LP, García-García L, Ferreyra-Reyes L, Delgado-Sánchez G, Bobadilla-Del-Valle M, Canizales-Quintero S, Ferreira-Guerrero E, Báez-Saldaña R, Téllez-Vázquez N, Montero-Campos R, Mongua-Rodriguez N, Martínez-Gamboa RA, Sifuentes-Osornio J, Ponce-de-León A. Association of diabetes and tuberculosis: impact on treatment and post-treatment outcomes. Thorax 2012; 68:214-20. [PMID: 23250998 PMCID: PMC3585483 DOI: 10.1136/thoraxjnl-2012-201756] [Citation(s) in RCA: 194] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Objective To determine the clinical consequences of pulmonary tuberculosis (TB) among patients with diabetes mellitus (DM). Methods We conducted a prospective study of patients with TB in Southern Mexico. From 1995 to 2010, patients with acid-fast bacilli or Mycobacterium tuberculosis in sputum samples underwent epidemiological, clinical and microbiological evaluation. Annual follow-ups were performed to ascertain treatment outcome, recurrence, relapse and reinfection. Results The prevalence of DM among 1262 patients with pulmonary TB was 29.63% (n=374). Patients with DM and pulmonary TB had more severe clinical manifestations (cavities of any size on the chest x-ray, adjusted OR (aOR) 1.80, 95% CI 1.35 to 2.41), delayed sputum conversion (aOR 1.51, 95% CI 1.09 to 2.10), a higher probability of treatment failure (aOR 2.93, 95% CI 1.18 to 7.23), recurrence (adjusted HR (aHR) 1.76, 95% CI 1.11 to 2.79) and relapse (aHR 1.83, 95% CI 1.04 to 3.23). Most of the second episodes among patients with DM were caused by bacteria with the same genotype but, in 5/26 instances (19.23%), reinfection with a different strain occurred. Conclusions Given the growing epidemic of DM worldwide, it is necessary to add DM prevention and control strategies to TB control programmes and vice versa and to evaluate their effectiveness. The concurrence of both diseases potentially carries a risk of global spreading, with serious implications for TB control and the achievement of the United Nations Millennium Development Goals.
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82
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Viswanathan V, Kumpatla S, Aravindalochanan V, Rajan R, Chinnasamy C, Srinivasan R, Selvam JM, Kapur A. Prevalence of diabetes and pre-diabetes and associated risk factors among tuberculosis patients in India. PLoS One 2012; 7:e41367. [PMID: 22848473 PMCID: PMC3406054 DOI: 10.1371/journal.pone.0041367] [Citation(s) in RCA: 161] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 06/20/2012] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is recognised as an important risk factor to tuberculosis (TB). India has high TB burden, along with rising DM prevalence. There are inadequate data on prevalence of DM and pre-diabetes among TB cases in India. Aim was to determine diabetes prevalence among a cohort of TB cases registered under Revised National Tuberculosis Control Program in selected TB units in Tamil Nadu, India, and assess pattern of diabetes management amongst known cases. METHODS 827 among the eligible patients (n = 904) underwent HbA1c and anthropometric measurements. OGTT was done for patients without previous history of DM and diagnosis was based on WHO criteria. Details of current treatment regimen of TB and DM and DM complications, if any, were recorded. A pretested questionnaire was used to collect information on sociodemographics, habitual risk factors, and type of TB. FINDINGS DM prevalence was 25.3% (95% CI 22.6-28.5) and that of pre-diabetes 24.5% (95% CI 20.4-27.6). Risk factors associated with DM among TB patients were age (31-35, 36-40, 41-45, 46-50, >50 years vs <30 years) [OR (95% CI) 6.75 (2.36-19.3); 10.46 (3.95-27.7); 18.63 (6.58-52.7); 11.05 (4.31-28.4); 24.7 (9.73-62.7) (p<0.001)], positive family history of DM [3.08 (1.73-5.5) (p<0.001)], sedentary occupation [1.69 (1.10-2.59) (p = 0.016)], and BMI (18.5-22.9, 23-24.9 and ≥25 kg/m(2) vs <18.5 kg/m(2)) [2.03 (1.32-3.12) (p = 0.001); 0.87 (0.31-2.43) (p = 0.78); 1.44 (0.54-3.8) (p = 0.47)]; for pre-diabetes, risk factors were age (36-40, 41-45, 46-50, >50 years vs <30 years) [2.24 (1.1-4.55) (p = 0.026); 6.96 (3.3-14.7); 3.44 (1.83-6.48); 4.3 (2.25-8.2) (p<0.001)], waist circumference [<90 vs. ≥90 cm (men), <80 vs. ≥80 cm (women)] [3.05 (1.35-6.9) (p = 0.007)], smoking [1.92 (1.12-3.28) (p = 0.017)] and monthly income (5000-10,000 INR vs <5000 INR) [0.59 (0.37-0.94) (p = 0.026)]. DM risk was higher among pulmonary TB [3.06 (1.69-5.52) (p<0.001)], especially sputum positive, than non-pulmonary TB. INTERPRETATION Nearly 50% of TB patients had either diabetes or pre-diabetes.
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Affiliation(s)
- Vijay Viswanathan
- Diabetology, M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu, India.
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Faurholt-Jepsen D, Range N, PrayGod G, Jeremiah K, Faurholt-Jepsen M, Aabye MG, Changalucha J, Christensen DL, Krarup H, Witte DR, Andersen AB, Friis H. The role of diabetes on the clinical manifestations of pulmonary tuberculosis. Trop Med Int Health 2012; 17:877-83. [DOI: 10.1111/j.1365-3156.2012.03002.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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84
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González-Salazar F, Vargas-Villarreal J, Garcialuna-Martínez F, Rivera G, Moreno-Treviño M, Montfort-Gardeazabal J, Garcialuna-Martínez E. Snapshot of Quantiferon TB gold testing in Northern Mexico. Tuberculosis (Edinb) 2011; 91 Suppl 1:S34-7. [DOI: 10.1016/j.tube.2011.10.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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85
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Park SW, Shin JW, Kim JY, Park IW, Choi BW, Choi JC, Kim YS. The effect of diabetic control status on the clinical features of pulmonary tuberculosis. Eur J Clin Microbiol Infect Dis 2011; 31:1305-10. [DOI: 10.1007/s10096-011-1443-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 09/30/2011] [Indexed: 11/30/2022]
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Ruslami R, Aarnoutse RE, Alisjahbana B, van der Ven AJAM, van Crevel R. Implications of the global increase of diabetes for tuberculosis control and patient care. Trop Med Int Health 2011; 15:1289-99. [PMID: 20955495 DOI: 10.1111/j.1365-3156.2010.02625.x] [Citation(s) in RCA: 149] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To review the current knowledge about tuberculosis (TB) and diabetes, assessing the implication of the global increase of diabetes for TB control and patient care. METHODS Systematic literature review. RESULTS Using public databases, it can be estimated that 12.6% (95% CI 9.2-17.3%) of new TB cases in the 10 countries with the highest TB burden will be attributable to TB in 2030, a relative increase of 25.5% compared to 2010. Diabetes is associated with a higher age and body weight among patients with TB, but probably not with a specific clinical presentation of TB. Rifampicin hampers glycemic control by increasing the metabolism of most oral antidiabetic drugs, while diabetes patients may have lower concentrations of anti-TB drugs. This might be one factor contributing to higher TB treatment failure rates. CONCLUSIONS The global epidemic of diabetes has implications for control and treatment of TB. Prospective studies are needed to improve prevention, early detection and treatment of concomitant diabetes and TB, especially in developing countries.
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Affiliation(s)
- Rovina Ruslami
- Department of Pharmacology, Faculty of Medicine, Universitas Padjadjaran/Hasan Sadikin Hospital, Bandung, Indonesia
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87
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Bailey SL, Grant P. 'The tubercular diabetic': the impact of diabetes mellitus on tuberculosis and its threat to global tuberculosis control. Clin Med (Lond) 2011; 11:344-7. [PMID: 21853830 PMCID: PMC5873743 DOI: 10.7861/clinmedicine.11-4-344] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The incidence and prevalence of diabetes mellitus (DM) is rapidly increasing across the globe. Tuberculosis (TB), meanwhile, remains a significant problem in low and middle income countries fuelled by high rates of HIV/AIDS. This article explores the long recognised but underappreciated connection between the two, revealing that DM makes a substantial contribution to the burden of incident TB around the world and may also worsen TB severity and treatment outcome. The dual management of the diseases may be challenging but must be addressed, both in low and high income settings, because the rising worldwide diabetes burden poses a threat to global TB control.
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88
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Baker MA, Harries AD, Jeon CY, Hart JE, Kapur A, Lönnroth K, Ottmani SE, Goonesekera SD, Murray MB. The impact of diabetes on tuberculosis treatment outcomes: a systematic review. BMC Med 2011; 9:81. [PMID: 21722362 PMCID: PMC3155828 DOI: 10.1186/1741-7015-9-81] [Citation(s) in RCA: 531] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 07/01/2011] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Multiple studies of tuberculosis treatment have indicated that patients with diabetes mellitus may experience poor outcomes.We performed a systematic review and meta-analysis to quantitatively summarize evidence for the impact of diabetes on tuberculosis outcomes. METHODS We searched PubMed, EMBASE and the World Health Organization Regional Indexes from 1 January 1980 to 31 December 2010 and references of relevant articles for reports of observational studies that included people with diabetes treated for tuberculosis. We reviewed the full text of 742 papers and included 33 studies of which 9 reported culture conversion at two to three months, 12 reported the combined outcome of failure and death, 23 reported death, 4 reported death adjusted for age and other potential confounding factors, 5 reported relapse, and 4 reported drug resistant recurrent tuberculosis. RESULTS Diabetes is associated with an increased risk of failure and death during tuberculosis treatment. Patients with diabetes have a risk ratio (RR) for the combined outcome of failure and death of 1.69 (95% CI, 1.36 to 2.12). The RR of death during tuberculosis treatment among the 23 unadjusted studies is 1.89 (95% CI, 1.52 to 2.36), and this increased to an effect estimate of 4.95 (95% CI, 2.69 to 9.10) among the 4 studies that adjusted for age and other potential confounding factors. Diabetes is also associated with an increased risk of relapse (RR, 3.89; 95% CI, 2.43 to 6.23). We did not find evidence for an increased risk of tuberculosis recurrence with drug resistant strains among people with diabetes. The studies assessing sputum culture conversion after two to three months of tuberculosis therapy were heterogeneous with relative risks that ranged from 0.79 to 3.25. CONCLUSIONS Diabetes increases the risk of failure and death combined, death, and relapse among patients with tuberculosis. This study highlights a need for increased attention to treatment of tuberculosis in people with diabetes, which may include testing for suspected diabetes, improved glucose control, and increased clinical and therapeutic monitoring.
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Affiliation(s)
- Meghan A Baker
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
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89
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Restrepo BI, Camerlin AJ, Rahbar MH, Wang W, Restrepo MA, Zarate I, Mora-Guzmán F, Crespo-Solis JG, Briggs J, McCormick JB, Fisher-Hoch SP. Cross-sectional assessment reveals high diabetes prevalence among newly-diagnosed tuberculosis cases. Bull World Health Organ 2011; 89:352-9. [PMID: 21556303 PMCID: PMC3089389 DOI: 10.2471/blt.10.085738] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 03/22/2011] [Accepted: 03/23/2011] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To estimate the contribution of clinically-confirmed diabetes mellitus to tuberculosis (TB) rates in communities where both diseases are prevalent as a way to identify opportunities for TB prevention among diabetic patients. METHODS This is a prospective study in which TB patients ≥ 20 years old at TB clinics in the Texas-Mexico border were tested for diabetes. The risk of tuberculosis attributable to diabetes was estimated from statistics for the corresponding adult population. FINDINGS The prevalence of diabetes among TB patients was 39% in Texas and 36% in Mexico. Diabetes contributed 25% of the TB cases studied, whereas human immunodeficiency virus (HIV) infection contributed 5% or fewer. Among TB patients, fewer Mexicans than Texans were aware that they had diabetes before this study (4% and 19%, respectively). Men were also less frequently aware than women that they had diabetes (P = 0.03). Patients who knew that they had diabetes before the study had an 8-year history of the disease, on average, before being diagnosed with TB. CONCLUSION Patients with diabetes are at higher risk of contracting TB than non-diabetic patients. Integrating TB and diabetes control programmes worldwide would facilitate TB prevention among diabetes patients and increase the number of diabetics who learn of their condition, particularly among males. Such a strategy would lead to earlier case detection and improve the management of both TB and diabetes.
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Affiliation(s)
- Blanca I Restrepo
- School of Public Health in Brownsville, University of Texas Health Science Center at Houston, Brownsville, 78520, USA.
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90
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Walsh MC, Camerlin AJ, Miles R, Pino P, Martinez P, Mora-Guzmán F, Crespo-Solis JG, Olivarez E, Fisher-Hoch SP, McCormick JB, Restrepo BI. The sensitivity of interferon-gamma release assays is not compromised in tuberculosis patients with diabetes. Int J Tuberc Lung Dis 2011; 15:179-iii. [PMID: 21219678 PMCID: PMC3085021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
SETTING AND OBJECTIVES the sensitivity of the interferon-gamma release assays (IGRAs) in the detection of Mycobacterium tuberculosis infection or disease may be affected by immune dysregulation in diabetes. As millions of type 2 diabetes patients are at risk for tuberculosis (TB) worldwide, it is important to determine if the sensitivity of IGRAs is compromised in this vulnerable population. DESIGN the sensitivity of the IGRAs QuantiFERON®-TB Gold (QFT-G) and T-SPOT®.TB was evaluated among specimens from newly diagnosed adults with microbiologically confirmed TB with and without diabetes. We also evaluated the association between QFT-G results and diabetes-associated conditions (dyslipidemia, obesity). RESULTS QFT-G sensitivity was 70% among TB patients. Patients with diabetes, chronic hyperglycemia or overweight/obesity were more than twice as likely to have positive test results in multivariate models (P < 0.05). Low high-density lipoprotein cholesterol or high triglycerides were not associated with assay results. In a separate group of TB patients (n = 43), T-SPOT.TB was 93% sensitive, with similar performance in patients with and without diabetes. CONCLUSION IGRA sensitivity is not compromised by diabetes in TB patients. Accordingly, IGRAs may also be suitable for diagnosing TB infection in diabetes patients, which is required to assess TB risk.
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Affiliation(s)
- Mary C. Walsh
- Division of Epidemiology, School of Public Health in Brownsville, University of Texas Health Science Center at Houston, Brownsville, Texas
| | - Aulasa J. Camerlin
- Division of Epidemiology, School of Public Health in Brownsville, University of Texas Health Science Center at Houston, Brownsville, Texas
| | - Reyna Miles
- Division of Epidemiology, School of Public Health in Brownsville, University of Texas Health Science Center at Houston, Brownsville, Texas
| | - Paula Pino
- Division of Epidemiology, School of Public Health in Brownsville, University of Texas Health Science Center at Houston, Brownsville, Texas
| | - Perla Martinez
- Division of Epidemiology, School of Public Health in Brownsville, University of Texas Health Science Center at Houston, Brownsville, Texas
| | | | | | | | - Susan P. Fisher-Hoch
- Division of Epidemiology, School of Public Health in Brownsville, University of Texas Health Science Center at Houston, Brownsville, Texas
| | - Joseph B. McCormick
- Division of Epidemiology, School of Public Health in Brownsville, University of Texas Health Science Center at Houston, Brownsville, Texas
| | - Blanca I. Restrepo
- Division of Epidemiology, School of Public Health in Brownsville, University of Texas Health Science Center at Houston, Brownsville, Texas
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Gillum RF, Albertorio-Díaz JR, Alpert JS. Disparities in rates of acute MI hospitalization and coronary procedures on the US-Mexico border. Am J Med 2010; 123:625-30. [PMID: 20609685 DOI: 10.1016/j.amjmed.2010.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 01/12/2010] [Accepted: 01/12/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Hospitalization rates for acute myocardial infarction can provide insight into the utilization of care by disadvantaged populations. However, these data have not been reported for the US-Mexico border region. METHODS Hospital discharge public use data files for 2000 were obtained from the health departments of Arizona, California, and Texas. The diagnosis of acute myocardial infarction was based on International Classification of Diseases-9th Revision, Clinical Modification code 410 as a primary discharge diagnosis. In addition, cardiac catheterization, coronary angioplasty, and bypass grafting procedures were enumerated. Discharges were classified as occurring in hospitals in border counties and nonborder counties. RESULTS Overall, 12,464 hospital discharges in border counties had acute myocardial infarction listed as the first diagnosis. Among those aged 45-64 and >or=65 years in border counties, Texas had the lowest discharge rates (eg, at >or=65 years: Texas 95, California 134 per 10,000), lower than in nonborder counties. Among those aged >or=65 years, rates in Texas also were lower in border than nonborder counties, a pattern not seen in other states. On the contrary, rates of catheterization and bypass grafting were highest in Texas, whereas the rates of bypass grafting were actually higher in border than in nonborder counties. In border and nonborder counties of the combined states, hospitalization rates of acute myocardial infarction in Hispanics were lower than those of non-Hispanics. Rates varied little between border and nonborder counties within ethnic groups. A similar pattern was observed for the hospital use of angioplasty and coronary bypass surgery. CONCLUSIONS Our findings suggest possible underutilization of hospital in-patient care for coronary artery disease by Hispanics who were residents of Texas border counties. Further studies are needed to test this hypothesis using more recent data.
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Tan CK, Lai CC, Chen HW, Liao CH, Chou CH, Huang YT, Yang WS, Yu CJ, Hsueh PR. Enzyme-linked immunospot assay for interferon-gamma to support the diagnosis of tuberculosis in diabetic patients. ACTA ACUST UNITED AC 2010; 42:752-6. [DOI: 10.3109/00365548.2010.490237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Littleton J, Park J. Tuberculosis and syndemics: Implications for Pacific health in New Zealand. Soc Sci Med 2009; 69:1674-80. [DOI: 10.1016/j.socscimed.2009.08.042] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Indexed: 10/20/2022]
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Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. THE LANCET. INFECTIOUS DISEASES 2009; 9:737-46. [PMID: 19926034 PMCID: PMC2945809 DOI: 10.1016/s1473-3099(09)70282-8] [Citation(s) in RCA: 541] [Impact Index Per Article: 36.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The link between diabetes mellitus and tuberculosis has been recognised for centuries. In recent decades, tuberculosis incidence has declined in high-income countries, but incidence remains high in countries that have high rates of infection with HIV, high prevalence of malnutrition and crowded living conditions, or poor tuberculosis control infrastructure. At the same time, diabetes mellitus prevalence is soaring globally, fuelled by obesity. There is growing evidence that diabetes mellitus is an important risk factor for tuberculosis and might affect disease presentation and treatment response. Furthermore, tuberculosis might induce glucose intolerance and worsen glycaemic control in people with diabetes. We review the epidemiology of the tuberculosis and diabetes epidemics, and provide a synopsis of the evidence for the role of diabetes mellitus in susceptibility to, clinical presentation of, and response to treatment for tuberculosis. In addition, we review potential mechanisms by which diabetes mellitus can cause tuberculosis, the effects of tuberculosis on diabetic control, and pharmacokinetic issues related to the co-management of diabetes and tuberculosis.
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Affiliation(s)
- Kelly E Dooley
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA
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Young F, Critchley JA, Johnstone LK, Unwin NC. A review of co-morbidity between infectious and chronic disease in Sub Saharan Africa: TB and diabetes mellitus, HIV and metabolic syndrome, and the impact of globalization. Global Health 2009; 5:9. [PMID: 19751503 PMCID: PMC2753337 DOI: 10.1186/1744-8603-5-9] [Citation(s) in RCA: 170] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 09/14/2009] [Indexed: 02/02/2023] Open
Abstract
Background Africa is facing a rapidly growing chronic non-communicable disease burden whilst at the same time experiencing continual high rates of infectious disease. It is well known that some infections increase the risk of certain chronic diseases and the converse. With an increasing dual burden of disease in Sub Saharan Africa the associations between diseases and our understanding of them will become of increased public health importance. Aims In this review we explore the relationships reported between tuberculosis and diabetes mellitus, human immunodeficiency virus, its treatment and metabolic risk. We aimed to address the important issues surrounding these associations within a Sub Saharan African setting and to describe the impact of globalization upon them. Findings Diabetes has been associated with a 3-fold incident risk of tuberculosis and it is hypothesised that tuberculosis may also increase the risk of developing diabetes. During co-morbid presentation of tuberculosis and diabetes both tuberculosis and diabetes outcomes are reported to worsen. Antiretroviral therapy for HIV has been associated with an increased risk of developing metabolic syndrome and HIV has been linked with an increased risk of developing both diabetes and cardiovascular disease. Globalization is clearly related to an increased risk of diabetes and cardiovascular disease. It may be exerting other negative and positive impacts upon infectious and chronic non-communicable disease associations but at present reporting upon these is sparse. Conclusion The impact of these co-morbidities in Sub Saharan Africa is likely to be large. An increasing prevalence of diabetes may hinder efforts at tuberculosis control, increasing the number of susceptible individuals in populations where tuberculosis is endemic, and making successful treatment harder. Roll out of anti-retroviral treatment coverage within Sub Saharan Africa is an essential response to the HIV epidemic however it is likely to lead to a growing number of individuals suffering adverse metabolic consequences. One of the impacts of globalization is to create environments that increase both diabetes and cardiovascular risk but further work is needed to elucidate other potential impacts. Research is also needed to develop effective approaches to reducing the frequency and health impact of the co-morbidities described here.
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Affiliation(s)
- Fiona Young
- Institute of Health and Society, Medical School, University of Newcastle upon Tyne, Newcastle upon Tyne, NE2 4HH, UK.
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96
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Blumenthal A, Isovski F, Rhee KY. Tuberculosis and host metabolism: ancient associations, fresh insights. Transl Res 2009; 154:7-14. [PMID: 19524868 DOI: 10.1016/j.trsl.2009.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 04/21/2009] [Accepted: 04/21/2009] [Indexed: 12/22/2022]
Abstract
Epidemiologic studies have repeatedly identified malnutrition as a risk factor for tuberculosis (TB), which is the leading bacterial cause of deaths worldwide. The biologic basis for this association, however, remains unclear. Recent work has uncovered a large array of signaling molecules lying at the intersection of metabolic and immune signaling, among which nuclear hormone receptors (NHRs) and the insulin receptor have emerged as 2 prototypic examples. Existing knowledge indicates that the physiologic functions of many NHRs overlap with known epidemiologic risk factors for TB and that diabetes, itself, predisposes to TB. Here, we assimilate these data and identify a potential mechanism that may help to explain the long-standing clinical association between TB and host metabolism. Together, these data emphasize the underused potential of interdisciplinary dialog in current TB research efforts.
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97
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Restrepo BI, Fisher-Hoch SP, Pino PA, Salinas A, Rahbar MH, Mora F, Cortes-Penfield N, McCormick JB. Tuberculosis in poorly controlled type 2 diabetes: altered cytokine expression in peripheral white blood cells. Clin Infect Dis 2009; 47:634-41. [PMID: 18652554 DOI: 10.1086/590565] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Although the biological basis for the increased susceptibility of diabetic patients to tuberculosis remains unclear, the world is undergoing a type 2 diabetes pandemic. We hypothesize that chronic hyperglycemia leads to immunocompromise that facilitates progression to active tuberculosis. To assess this possibility, we determined whether patients with tuberculosis and diabetes (particularly those with chronic hyperglycemia), compared with patients with tuberculosis who did not have diabetes, presented altered cytokine responses to a mycobacterial antigen. METHODS Samples of whole blood from patients with tuberculosis and diabetes and from patients with tuberculosis who did not have diabetes was stimulated in vitro with purified protein derivative from Mycobacterium tuberculosis. We then determined whether there was an association between the levels of innate and adaptive cytokines secreted in response to the antigen and diabetes status, or diabetes with chronic hyperglycemia (measured by glycosylated hemoglobin level), after controlling for possible confounders. RESULTS Innate and type 1 cytokine responses were significantly higher in patients with tuberculosis who had diabetes than in nondiabetic control subjects. The effect was consistently and significantly more marked in diabetic patients with chronic hyperglycemia. CONCLUSIONS These data provide preliminary evidence that type 2 diabetes, especially type 2 diabetes involving chronic hyperglycemia, is associated with an altered immune response to M. tuberculosis. More-detailed knowledge of the underlying mechanisms should focus on the effect of chronic hyperglycemia on the immune response to help in understanding the enhanced susceptibility of diabetic patients to tuberculosis.
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Affiliation(s)
- Blanca I Restrepo
- Division of Epidemiology, University of Texas Health Science Center at Houston, School of Public Health, University of Texas at Brownsville, 80 Fort Brown, SPH Bldg., Brownsville, TX 78520, USA.
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98
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Waterman SH, Escobedo M, Wilson T, Edelson PJ, Bethel JW, Fishbein DB. A new paradigm for quarantine and public health activities at land borders: opportunities and challenges. Public Health Rep 2009; 124:203-11. [PMID: 19320361 DOI: 10.1177/003335490912400207] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The Institute of Medicine (IOM) report Quarantine Stations at Ports of Entry: Protecting the Public's Health focused almost exclusively on U.S. airports and seaports, which served 106 million entries in 2005. IOM concluded that the primary function of these quarantine stations (QSs) should shift from providing inspection to providing strategic national public health leadership. The large expanse of our national borders, large number of crossings, sparse federal resources, and decreased regulation regarding conveyances crossing these borders make land borders more permeable to a variety of threats. To address the health challenges related to land borders, the QSs serving such borders must assume unique roles and partnerships to achieve the strategic leadership and public health research roles envisioned by the IOM. In this article, we examine how the IOM recommendations apply to the QSs that serve the land borders through which more than 319 million travelers, immigrants, and refugees entered the U.S. in 2005.
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Affiliation(s)
- Stephen H Waterman
- Quarantine and Border Health Services Branch, Division of Global Migration and Quarantine, National Center for Preparedness, Detection, and Control of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Clinical Manifestations and Outcome of Tuberculosis in Diabetic Patients Admitted to King Abdulaziz University Hospital in Jeddah, Saudi Arabia. J Taibah Univ Med Sci 2009. [DOI: 10.1016/s1658-3612(09)70103-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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100
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Cadena J, Hartzler A, Hsue G, Longfield RN. Coccidioidomycosis and tuberculosis coinfection at a tuberculosis hospital: clinical features and literature review. Medicine (Baltimore) 2009; 88:66-76. [PMID: 19352301 DOI: 10.1097/md.0b013e318194757a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Tuberculosis (TB) and coccidioidomycosis can have similar clinical and radiologic presentations but require different treatments. Coinfection with TB and Coccidioides immitis is uncommonly reported and may be underdiagnosed in endemic areas.We performed a retrospective review of the medical records of all patients admitted to a TB referral hospital between 1995 and 2007, and selected all cases of TB and coccidioidomycosis coinfection in patients aged 18 years or older. All admitted patients had a diagnosis of TB and had sputum cultures for both pathogens. We reviewed clinical, laboratory, and radiologic features of the cases, and noted antimicrobial treatments received and outcomes.We identified 9 patients, of whom 7 (78%) were Hispanic. Most patients were male (8/9, 89%), and all were diagnosed with coccidioidomycosis after TB. Three (33%) patients had drug-resistant TB. Six patients had culture-positive TB at the time of the double diagnosis, and 2 patients developed active coccidioidomycosis during their hospital stay. Only 1 had human immunodeficiency virus/acquired immunodeficiency syndrome (HIV-AIDS) (CD4 count, 20 cells/mm). All but 2 patients were treated with antifungal agents. Two patients died, 1 of whom had AIDS. Radiologic studies were unable to distinguish between TB and coccidioidomycosis, except for a patient who developed a new air-fluid level in a previously stable cavity.TB and coccidioidomycosis coinfection should be suspected in coccidioidomycosis-endemic regions among patients with TB who fail to improve clinically or radiologically despite adequate, culture-directed therapy.
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