Prevalence and associated factors of diabetes mellitus among tuberculosis patients in Brunei Darussalam: A 6-year retrospective cohort study

Prevalence and Risk Factors of Diabetes in Patients with Active Pulmonary Tuberculosis: A Cross-Sectional Study in Two Financially Affluent China Cities

Background

Tuberculosis (TB) and diabetes mellitus (DM) present a dual burden to public health. The screening of DM in TB patients may aid in the early detection and management of diabetes, ultimately improving treatment outcomes for those with the comorbidity of TB-DM. We aim to examine the prevalence and identify risk factors of diabetes in individuals with active pulmonary tuberculosis (PTB) in financially affluent China cities.

Methods

A cross-sectional survey was conducted in adult patients with highly suspected TB in two cities of China, spanning from May 9, 2023, to June 30, 2023. We compare the clinical characteristics, nutrition status, fasting blood glucose (FBG) level, living style, and knowledge of TB and DM at admission between patients with and without DM. Univariate and multivariate logistic regression analyses were employed to identify risk factors associated with TB-DM comorbidities.

Results

Of the 322 patients diagnosed with pulmonary tuberculosis (PTB), 54 individuals (16.8%) had comorbid diabetes mellitus (DM). This included 43 males (13.4%) and 11 females (3.4%). The average age was 55.44 ± 12.36 in DM patients and 46.09 ± 16.87 in non-DM patients. A multivariate logistic regression analysis revealed that male (adjusted odds ratio [aOR]=3.29, 95% confidence interval [CI]: 1.05-10.30), age older than 47 years (aOR = 1.04, 95% CI: 1.01-1.07), having a family history of diabetes (aOR = 5.09, 95% CI: 1.28-20.32), and an elevated random blood glucose level (aOR = 1.6, 95% CI: 1.38-1.86) were risk factors for DM in patients with PTB. Furthermore, it was found that diabetes awareness (aOR = 0.07, 95% CI: 0.03-0.21) and zero, light to moderate alcohol consumption were associated with a lower risk of diabetes.

Conclusion

Diabetes is prevalent in patients with active PTB. Screening and raising awareness of DM are recommended, particularly in men after middle age with a family history of diabetes and elevated random blood glucose. Early diagnosis of diabetes and effective diabetes prevention may reduce the dual burden of TB-DM comorbidity.

Prevalence and Associated Factors of Diabetes Mellitus Among Newly Enrolled Tuberculosis Patients in Lubumbashi (DRC)

Background

Tuberculosis and diabetes mellitus are major public health challenges worldwide. The two scourges have bidirectional relationship with high morbidity and mortality.

Objective

The present study was conducted to determine the prevalence of diabetes mellitus and identify related factors in patients with tuberculosis.

Methods

A cross-sectional study was conducted in 11 tuberculosis screening and treatment centers in Lubumbashi (DRC) from September to December 2022. Adult patient with a positive smear for tuberculosis were systematically screened for diabetes mellitus. Demographic characteristics, history and symptomatology were the variables of interest. Data was entered using Microsoft Excel software. STATA 16 software was used for analysis.

Results

A total of 255 tuberculosis patients were recruited and the prevalence of diabetes mellitus among these patients was 11.4% (ie, 29 out of 255). After uni and multivariate logistic regression, a BMI ≤ 18.5 Kg/m2, lack of employment, polyuria and intense thirst were the factors associated with diabetes mellitus in tuberculosis patients.

Conclusion

The prevalence of diabetes mellitus in smear positive tuberculosis patients in the present study was higher than the one observed in Central Africa.

The cause-effect relation of tuberculosis on incidence of diabetes mellitus

Tuberculosis (TB) is one of the oldest human diseases and is one of the major causes of mortality and morbidity across the Globe. Mycobacterium tuberculosis (Mtb), the causal agent of TB is one of the most successful pathogens known to mankind. Malnutrition, smoking, co-infection with other pathogens like human immunodeficiency virus (HIV), or conditions like diabetes further aggravate the tuberculosis pathogenesis. The association between type 2 diabetes mellitus (DM) and tuberculosis is well known and the immune-metabolic changes during diabetes are known to cause increased susceptibility to tuberculosis. Many epidemiological studies suggest the occurrence of hyperglycemia during active TB leading to impaired glucose tolerance and insulin resistance. However, the mechanisms underlying these effects is not well understood. In this review, we have described possible causal factors like inflammation, host metabolic changes triggered by tuberculosis that could contribute to the development of insulin resistance and type 2 diabetes. We have also discussed therapeutic management of type 2 diabetes during TB, which may help in designing future strategies to cope with TB-DM cases.

Prevalence of Diabetes Mellitus among Patients with Tuberculosis and Its Associated Factors in Sana'a, Yemen, 2021

Diabetes mellitus (DM) is one of tuberculosis' (TB) ending barriers. TB patients with DM are at a higher risk than non-diabetes patients to develop complication, relapse and die. In Yemen, information on TB-DM comorbidity is lacking. This study aimed to determine the prevalence and associated factors of diabetes among TB patients at the National Tuberculosis Center (NTC) in Sana'a. A facility-based cross-sectional study was conducted. All TB patients aged >15 years who attended the NTC from July to November 2021 were screened for DM. Socio-demographic and behavioral information were collected through face-to-face interviews using questionnaires. A total of 331 TB patients were enrolled, 53% were males, 58% aged <40 years, and 74% were newly diagnosed with TB. Overall, DM prevalence was 18%. Higher rates of DM were found among TB patients that were male (OR = 3.0; 95% CI; 1.4-6.7), ≥50 years of age (OR = 10.8; 95% CI; 4.3-27.3), and those with a family history of diabetes (OR = 3.4; 95% CI; 1.6-6.9). Almost one fifth of TB patients had DM. The early detection of DM through immediate screening after a TB diagnosis and periodically during the course of treatment is crucial for TB patients' optimal care. Dual diagnostics for reducing the dual burden of TB-DM comorbidity is recommended.

Diabetes Mellitus and Its Therapy in Brunei Darussalam - A Critical Revisit

Introduction

Diabetes is becoming an increasingly common condition across the world including Brunei Darussalam. Bruneian population, although is relatively small, represents a miniature urban community of neighbouring Southeast Asian countries as they share similar dietary and ethnicity patterns. Thus, it would be valuable to examine the findings of studies conducted among Bruneians. This study aimed to identify and review research related to the practice of patients with DM in Brunei Darussalam in order to identify associated factors influencing diabetic medication knowledge and adherence.

Methods

This narrative review analyzed literature related to DM and its therapy in Brunei Darussalam. Other issues consisting of knowledge and adherence related to DM were also explored. Databases (Scopus, PubMed, and Google Scholar) were used to search literature published up to May 2022. Search terms "diabetes mellitus", "Brunei" combined using Boolean operator were used.

Results and Discussion

Conducting appropriate studies in Brunei Darussalam can benefit the government and policymakers to implement effective measures and programmes to combat the diabetes epidemic. Despite the government's efforts, additional relevant stakeholders must be included in order to work together and engage in these initiatives in order to increase diabetes awareness, give people the power to make healthy decisions, and ultimately reduce the prevalence of diabetes in Brunei Darussalam. Patients' medication knowledge proficiency plays a main component of ensuring appropriate and safe use of medication prescribed to them.

Conclusion

Relatively poor medication knowledge and inappropriate diabetes-related practices were observed in studies conducted in Brunei Darussalam. However, no study has been done which directly measures both medication awareness and compliance among Brunei Darussalam T2DM patients. Future studies can focus on the relation between these two factors in different geographical locations of the world that are characterized by different diabetes-related practices and culture.

Medication Knowledge and Adherence in Type 2 Diabetes Mellitus Patients in Brunei Darussalam: A Pioneer Study in Brunei Darussalam

Aim: The present study measured the medication knowledge and medication adherence in patients with type 2 diabetes in Brunei Darussalam. Demographic details and diabetes knowledge were also evaluated. Methods: A cross-sectional study conducted via the administration of a structured questionnaire consisting of 4 sections via a face-to-face interview. Results: A total of 118 participants were interviewed. A majority of the participants were aged 40 years or above (106, 89.8%). The mean number of total medications that the participants were taking was 7.36 ± 2.87 and the mean number of antidiabetic medications was 2.39 ± 1.06. As for the antidiabetic therapy, the largest proportion of the participants were taking oral antidiabetic medications only (87, 73.73%). In the diabetes knowledge section of the questionnaire, more than half of the participants (63, 53.34%) scored higher than the acquired mean score. Family history, education level, and total medications taken were significantly correlated with diabetes knowledge. However, in the medication knowledge section of the questionnaire, the mean score (3.37 ± 1.38) was below the intended score for good knowledge. Medication knowledge has been significantly associated with gender, family history and total medications taken. A majority of the participants reported non-adherence (74, 62.71%) due to various reasons. In this study, those of the Malay race were significantly correlated with adherence to their medication regimen. This study also revealed that there is no significant relationship between diabetes knowledge, medication knowledge and medication adherence. Conclusions: The present study provides insights in regard to patients with type 2 diabetes in Brunei Darussalam and their knowledge towards the disease as well as their medications. Despite the lack of significance between the variables, the rate of non-adherence is still alarming. Further studies are required to better understand the barriers to non-adherence in these patients.

Contact investigation of tuberculosis in Brunei Darussalam: Evaluation and risk factor analysis

Introduction

We evaluated the yield of tuberculosis (TB) contact investigation in Brunei Darussalam, and identified the associated factors for latent TB infection (LTBI) diagnosis, as well as for initiating and completing LTBI treatment.

Methods

Data were extracted and digitalised for all close contacts of pulmonary TB (PTB) cases at the National TB Coordinating Centre from January 2009 to December 2018. Generalising estimating equations logistic regression models were used to determine the associated factors. Manual matching against electronic health records system was done to identify contacts who had progressed to active TB disease.

Results

Among 10 537 contacts, 9.9% (n=1047) were diagnosed as LTBI, out of which 43.0% (n=450) initiated LTBI treatment. Among those who initiated, 74.0% (n=333) completed LTBI treatment. Contact factors associated with LTBI diagnosis include being male (adjusted OR (aOR)=1.18 (95% CI 1.03 to 1.34)), local (aOR=0.70 (95% CI 0.56 to 0.88)) and a household contact (aOR=1.59 (95% CI 1.26 to 1.99)). Contacts of index cases who were <60 years old and diagnosed as smear positive PTB (aOR=1.62 (95% CI 1.19 to 2.20)) had higher odds of being diagnosed with LTBI. Local LTBI cases had higher odds of initiating LTBI treatment (aOR=1.86 (95% CI 1.26 to 2.73)). Also, LTBI cases detected from local (aOR=2.32 (95% CI 1.08 to 4.97)) and smear positive PTB index cases (aOR=2.23 (95% CI 1.09 to 4.55)) had higher odds of completing LTBI treatment. Among 1047 LTBI cases, 5 (0.5%) had progressed to active PTB within 1–8 years post-LTBI diagnosis.

Discussion

LTBI burden is disproportionately high towards foreign nationals, with higher odds of LTBI diagnosis but lower odds of treatment initiation. Determining the reasons of not initiating LTBI treatment will be useful to help improve LTBI treatment uptake. Establishing digital databases and building TB laboratory capacity for molecular typing would be useful to determine the contribution of LTBI or reactivation towards TB incidence in Brunei.

Association between climate variables and pulmonary tuberculosis incidence in Brunei Darussalam

We investigated the association between climate variables and pulmonary tuberculosis (PTB) incidence in Brunei-Muara district, Brunei Darussalam. Weekly PTB case counts and climate variables from January 2001 to December 2018 were analysed using distributed lag non-linear model framework. After adjusting for long-term trend and seasonality, we observed positive but delayed relationship between PTB incidence and minimum temperature, with significant adjusted relative risk (adj.RR) at 25.1 °C (95th percentile) when compared to the median, from lag 30 onwards (adj.RR = 1.17 [95% Confidence Interval (95% CI): 1.01, 1.36]), suggesting effect of minimum temperature on PTB incidence after 30 weeks. Similar results were observed from a sub-analysis on smear-positive PTB case counts from lag 29 onwards (adj.RR = 1.21 [95% CI: 1.01, 1.45]), along with positive and delayed association with total rainfall at 160.7 mm (95th percentile) when compared to the median, from lag 42 onwards (adj.RR = 1.23 [95% CI: 1.01, 1.49]). Our findings reveal evidence of delayed effects of climate on PTB incidence in Brunei, but with varying degrees of magnitude, direction and timing. Though explainable by environmental and social factors, further studies on the relative contribution of recent (through primary human-to-human transmission) and remote (through reactivation of latent TB) TB infection in equatorial settings is warranted.

The prevalence of diabetes among tuberculosis patients in Denmark

SETTING

It is estimated that 25% of the world's population are infected with Mycobacterium tuberculosis and that 463 million people are living with diabetes mellitus (DM), a number that is increasing. Patients with DM have three times the risk of developing tuberculosis (TB) and there is significant interaction between DM and TB, suggesting that DM affects not only risk of TB but also TB presentation, treatment response and outcome.

OBJECTIVE

The aim was determining the prevalence of DM among TB patients in Denmark and to assess risk factors.

DESIGN

Patient files from all notified TB cases in Denmark from 2009 to 2014 were retrospectively assessed.

RESULTS

In total, 1912 patients were included and 5.0% had DM. Patients with DM were older, had more comorbidities, came from outside Denmark, and had a higher mortality compared to non-DM-patients. None of the patients from Greenland had DM. Patients with low socio-economic status had a low prevalence of DM. We found a higher prevalence of DM among Danish-born < 54 year and migrant ≥ 75 year compared to a Danish background population.

CONCLUSION

We found a higher prevalence of DM among TB patients with known risk factors, and a surprisingly low prevalence among patients with low socioeconomic status and patients from Greenland.

Impact of Multimorbidity Subgroups on the Health Care Use and Clinical Outcomes of Patients With Tuberculosis: A Population-Based Cohort Analysis

Background: Multimorbidity is defined as the existence of two or more chronic health conditions in the same individual. While patients with tuberculosis commonly have multiple conditions at diagnosis, such as HIV, diabetes, and depression, to the authors' knowledge, there is limited information on the patterns of multimorbidity, and how the types and combinations of conditions could impact the healthcare utilization, expenditure, and TB outcomes.

Methods: An observational cohort study of adult patients diagnosed with tuberculosis was conducted using the Chinese Center for Disease Control and Prevention (CDC)'s National TB Information System (NTBIS) linked to the Ningbo Regional Health Care Database (NRHCD) (2015–2020). Latent class analysis was used to identify comorbidity groups among the subset with ≥2 conditions including TB. Group-level health care use, expenditure, and treatment outcomes were compared with patients without chronic conditions using multivariate regression models.

Results: A total of 9,651 patients with TB were identified, of whom approximately 61.4% had no chronic conditions, 17.4% had 1 chronic condition, and 21.3% had ≥2 chronic conditions. Among those with ≥1 chronic condition other than TB, 4 groups emerged: (1) general morbidity (54.4%); (2) cardiovascular morbidity without complications (34.7%); (3) cardiovascular morbidity with complications (5.0%); (4) respiratory morbidity (5.9%). The respiratory morbidity group experienced the highest expenditures, at 16,360 CNY more overall (95% CI, CNY 12,615–21,215) after adjustment compared with TB patients without chronic conditions. The respiratory morbidity and cardiovascular morbidity with complications group also had the lowest odds of favorable TB outcomes [adjusted odds ratio (aOR), 0.68; 95% CI, 0.49–0.93] and (aOR 0.59, 95% CI 0.42–0.83), respectively. The cardiovascular morbidity without complications group had the highest odds of successful TB treatment (aOR, 1.40; 95% CI, 1.15–1.71).

Conclusions: Multimorbidity is common among patients with TB. The current study identified four distinct comorbidity subgroups, all of which experienced high, yet differential, rates of health care use. These findings highlight the need for urgent reforms to transform current fragmented TB care delivery and improve access to other specialists and financial assistance.