Association of tuberculosis and diabetes Mellitus: an analysis of 1000 consecutively admitted cases in a tertiary care hospital of North India

Predictors of extrapulmonary tuberculosis among diabetic patients at Debre Markos compressive specialized hospital, Ethiopia, 2021: A retrospective cohort study

BACKGROUND

Extrapulmonary tuberculosis is an emerging public health problem among diabetic patients. Diabetes, which causes immunosuppression, is increasingly being recognized as an independent risk factor for tuberculosis, and the two often coexist and impact each other. Therefore, this study aimed to investigate the incidence and predictors of extra pulmonary tuberculosis among diabetic patients at Debre Markos referral hospital, Northwest Ethiopia.

METHODS

This institutionally-based retrospective cohort study was undertaken among 433 diabetic patients of Debre Markos compressive specialized hospital between January 2016 to December 2020. All eligible diabetic patients who full filled the inclusion criteria were included in the study. Data were entered using Epi-data Version 3.1 and analyzed using STATA Version 14. The survival time of diabetic patients was estimated using the Kaplan-Meier survival curve, and the survival time between different categorical variables was compared using the log rank test. Both bi-variable and multivariable Cox-proportional hazard regression models were fitted to identify independent predictors of tuberculosis among diabetic patients.

RESULTS

Among a cohort of 433 diabetic patients at Debre Markos compressive specialized hospital, 17(3.9%) developed extra pulmonary tuberculosis during the follow-up time. The total time allotted to follow up the study participants was 1101.5 person-years (PY). The overall extra pulmonary tuberculosis incidence rate was 1.5 per 100 PY with 95% CI. Using the multivariable Cox-regression analysis, age (AIR 4.8 (95% CI (1.2-20.7), 0.03), diabetic medication (AIR 1.4 (95% CI(1.24-16), 0.03), having past history of PTB before diabetic follow up initiation (AID 1.5(95% CI (3.2-6.9),0.01) and having history of alcohol (AIR (95%CI (4(1.2-13),0.02) were significantly increased the risk of extra pulmonary tuberculosis while BMI (18.5-25) AIR(95% CI (0.22 (0.06-0.76), 0.02) was associated with a rate reduction for the incidence of extra pulmonary tuberculosis.

CONCLUSIONS

In this study, we found a high rate of extra pulmonary tuberculosis among diabetic patients. Factors significantly linked with increased risk of extra pulmonary tuberculosis included: age, using insulin as hypoglycemic medication, having past history of PTB before diabetic follow up initiation and alcoholic history while BMI was associated with a rate reduction of EPTB. Early screening and treatment for extra pulmonary tuberculosis is highly recommended at diabetes mellitus follow up for patients with the above risk factors.

Diabetes mellitus and prediabetes among patients with tuberculosis in a single north Indian tertiary care centre

BACKGROUND

Prevalence of diabetes mellitus (DM), though believed to be high among patients with tuberculosis (TB), remains unclear for the want of systematic studies and unequivocal methods of diagnosing DM. This study was done to determine the prevalence of prediabetes and DM in adult patients with TB.

METHODS

This prospective study of one year's duration, carried out at a tertiary care centre included 313 consecutive adult patients diagnosed (either microbiologically, histologically or based on clinical presentation) with pulmonary or extrapulmonary TB. Those without a history of pre-existing DM were subjected to oral glucose tolerance test (OGTT) with 75 g glucose.

RESULTS

In this cohort 85 (27%) patients had pre-existing DM. The remaining 228 patients not diagnosed earlier with DM underwent a 75 g OGTT, of which 63 (28%) were found to have newly detected prediabetes (impaired fasting glucose [IFG] and impaired glucose tolerance [IGT] alone in 36 and 10 patients respectively and both IFG and IGT in a further 17) and DM was diagnosed in 9 (4%) patients (fasting blood glucose [FBG] ˜ 126 mg/dl in 1 and both FBG ˜ 126 mg/dl and 2-h plasma blood glucose [PLBG] ˜ 200 mg/dl in 8 patients). The total prevalence of (newly diagnosed) DM and prediabetes, therefore, was 32% (72 patients); the overall prevalence of DM was 30% (94 patients).

CONCLUSION

This study found high prevalence of prediabetes and diabetes among patients with TB. This underscores the need for a bidirectional screening strategy to improve diagnosis and outcome of both TB and DM.

Forecasting the impact of diabetes mellitus on tuberculosis disease incidence and mortality in India

Background

In context of the rapidly expanding diabetes mellitus (DM) epidemic in India and slowly declining tuberculosis (TB) incidence, we aimed to estimate the past, current, and future impact of DM on TB epidemiology.

Methods

An age-structured TB-DM dynamical mathematical model was developed and analyzed to assess the DM-on-TB impact. The model was calibrated using a literature review and meta-analyses. The DM-on-TB impact was analyzed using population attributable fraction metrics. Sensitivity analyses were conducted by accommodating less conservative effect sizes for the TB-DM interactions, by factoring the age-dependence of the TB-DM association, and by assuming different TB disease incidence rate trajectories.

Results

In 1990, 11.4% (95% uncertainty interval (UI) = 6.3%-14.4%) of new TB disease incident cases were attributed to DM. This proportion increased to 21.9% (95% UI = 12.1%-26.4%) in 2017, and 33.3% (95% UI = 19.0%-44.1%) in 2050. Similarly, in 1990, 14.5% (95% UI = 9.5%-18.2%) of TB-related deaths were attributed to DM. This proportion increased to 28.9% (95% UI = 18.9%-34.1%) in 2017, and 42.8% (95% UI = 28.7%-53.1%) in 2050. The largest impacts originated from the effects of DM on TB disease progression and infectiousness. Sensitivity analyses suggested that the impact could be even greater.

Conclusions

The burgeoning DM epidemic is predicted to become a leading driver of TB disease incidence and mortality over the coming decades. By 2050, at least one-third of TB incidence and almost half of TB mortality in India will be attributed to DM. This is likely generalizable to other Asian Pacific countries with similar TB-DM burdens. Targeting the impact of the increasing DM burden on TB control is critical to achieving the goal of TB elimination by 2050.

Incidence and Predictors of Tuberculosis among Adult Diabetic Patients, Debre Markos Referral Hospital, Northwest Ethiopia, 2018: A Retrospective Cohort Study

BACKGROUND

Tuberculosis remains a serious global public health problem. It mainly affects the lungs, and occurs in every part of the world. The link between tuberculosis and diabetes mellitus is essential to inform programs and policies, yet there is a scarcity of information in our study area. Therefore, this study aimed to investigate the incidence and predictors of tuberculosis among diabetic patients at Debre Markos Referral Hospital, northwest Ethiopia.

METHODS

This institutionally based retrospective cohort study was undertaken among 433 diabetic patients of Debre Markos Referral Hospital between January 2013 and December 2017. All eligible diabetic patients who met the inclusion criteria were included in the study. Data were entered using EpiData version 3.1 and analyzed using Stata version 14. The survival time of diabetic patients was estimated using Kaplan-Meier survival curves, and survival time among different categorical variables compared using the log-rank test. Both bivariate and multivariate Coxproportional-hazard regression models were fitted to identify independent predictors of tuberculosis among diabetic patients.

RESULTS

Among the cohort of 43326 (6%) developed tuberculosis during follow-up. The overall tuberculosis-incidence rate was 2.4 per 100 with 95% CI. The total time allotted to follow up the study participants was 1,101.5 person-years. Using multivariate Cox regression analysis, history of alcohol consumption (adjusted incidence ratio 4, 95% CI 1.2-13; P=0.02) and history of tuberculosis (12, 95% CI 3-39; P=0.01) significantly increased the risk of tuberculosis, but normal body-mass index and above (≥18.5 kg/m²) was associated with a rate reduction (0.34, 95% CI 0.14; P=0.80; 0.03) forincidence of tuberculosis.

CONCLUSION

In this study, we found a high rate of tuberculosis among diabetic patients. Factors significantly linked with increased risk of tuberculosis included history of alcohol consumption, history of tuberculosis, and low body-mass index. Early screening and treatment for tuberculosis is highly recommended at diabetes mellitus follow-up for patients with these risk factors.

The impact of diabetics and smoking on gender differences of smear positive pulmonary tuberculosis incidence

BACKGROUND

Several determinants are responsible for different incidences of smear positive pulmonary tuberculosis (TB). The main determinants are cigarette smoking and diabetes mellitus. The aim of this study is to determine the effect of these risk factors effect modifiers in TB/gender association.

METHODOLOGY

In this retrospective cohort, relative risk of gender in developing smear positive TB as well as its interaction with smoking and diabetes mellitus were investigated.

RESULTS

Of 1243 smear positive TB cases, 63.2% were male. Prevalences of diabetes mellitus among men and women TB cases were 9.2% and 22.9% respectively (p<0.001). Frequency of cigarette smoking among men was significantly higher than that in women (61.7% vs. 7.6% respectively, p<0.001). Male gender, increased the risk of developing smear positive TB as of 98% and 5% in smokers and non-smokers respectively (p=0.001), indicating an interaction between gender and smoking in the effect on TB. In addition, male gender increased the risk of TB as of 13% and 34% in patients with and without diabetes mellitus respectively (p=0.300) indicating no interaction between gender and diabetes mellitus on TB incidence.

CONCLUSION

Our study showed that cigarette smoking is a determinant factor for gender differences in TB incidence but diabetes mellitus does not affect the association between TB and gender.