Meta-analysis of the prevalence of tuberculosis in diabetic patients and its association with cigarette smoking in African and Asian countries

The collaborative framework for the management of tuberculosis and type 2 diabetes syndemic in low- and middle-income countries: a rapid review

INTRODUCTION

Given the absence of international guidelines on the joint management and control of tuberculosis (TB) and type 2 diabetes mellitus (T2D), the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (The Union) launched in 2011 a policy framework to address the growing syndemic burden of TB-T2D. This review aimed at mapping the available evidence on the implementation of the Union-WHO Framework, explicitly, or bi-directional TB-T2D health programs as an initiative for co-management in patients in low- and middle-income countries (LMIC).

METHODS

A rapid review was performed based on a systematic search in PubMed and Web of Science electronic databases for peer-reviewed articles on The Union-WHO Framework and bi-directional interventions of TB and T2D in LMIC. The search was restricted to English language articles and from 01/08/2011 to 20/05/2022.

RESULTS

A total of 24 articles from 16 LMIC met the inclusion criteria. Four described the implementation of The Union-WHO Framework and 20 on the bi-directional interventions of TB and T2D. Bi-directional activities were found valuable, feasible and effective following the Union-WHO recommendations. Limited knowledge and awareness on TB-T2D comorbidity was identified as one of the barriers to ensure a functional and effective integration of services.

CONCLUSIONS

This review revealed that it is valuable, feasible and effective to implement bi-directional TB and T2D activities (screening and management) according to the Union-WHO Framework recommendations, especially in countries that face TB-T2D syndemic. Additionally, it was apparent that gaps still exist in research aimed at providing evidence of costs to implement collaborative activities. There is need for TB and T2D services integration that should be done through the well-stablished TB programme. This integration of two vertical programmes, could ensure patient-centeredness, continuum of care and ultimately contribute for health systems strengthening.

Effect of Tuberculosis (TB) and Diabetes mellitus (DM) integrated healthcare on bidirectional screening and treatment outcomes among TB patients and people living with DM in developing countries: a systematic review

A systematic review (Prospero CRD42017075562) including articles published between 1 January 1990 and 31 October 2021 was performed to synthesize evidence on the effect of integrating tuberculosis (TB) and diabetes mellitus (DM) healthcare on screening coverage and treatment loss to follow-up as compared to non-integrated care services for TB and DM in low- to middle-income countries (LMICs). Searches were performed in PubMed, Web of Science, WHO Global Index Medicus, and Cochrane Central Library. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and we adopted Cochrane data collection form for Randomized Controlled Trials (RCTs) and non-RCTs. Due to heterogeneity and limited data of studies included, meta-analysis was not performed. Of 6902 abstracts, 10 studies from South America, Asia, and Africa were included. One study from Zimbabwe showed 57% increase in DM screening among TB patients in integrated care as compared to non-integrated care; 95% CI: 54.1, 59.8. Seven studies with before-after comparison groups reported increased screening coverage during implementation of integrated healthcare that ranged from 10.1% in Mexico to 99.1% in China. Three studies reported reduction in loss to follow-up among TB patients in integrated care; two in China showed 9.2%, 95% CI: -16.7, -1.7, and -9.5%, 95% CI: -18.4, -0.7 differences, while a study from Mexico showed -5.3% reduction, 95% CI: -9.8, -0.9.With few and heterogenous included studies, the synthesized evidence is weak to establish effect of TB/DM integrated care. Therefore, further robust studies such as randomized clinical trials and well-designed observational studies are needed.

Tobacco Use and Cessation Counseling among Dental Professionals in Saudi Arabia

The study aimed to assess the prevalence of tobacco use among dental professionals and their attitudes and behaviors about tobacco cessation counseling in Saudi Arabia. A total of 359 male and female dental professionals participated in this cross-sectional study. A pretested self-administered questionnaire was administered among study participants by visiting dental hospitals and clinics in Saudi Arabia. In the study, 15.9% of the participants were current tobacco users and 50.4% had a tobacco user at home or the workplace. Most participants reported that tobacco use is associated with bad breath (88.9%), oral cancer (88.3%), dryness of the mouth (80.8%), and bad taste (79.9%). Most participants asked patients about their tobacco habits (86.6%), mentioned tobacco habits in patient records (71.3%), and explained the benefits of quitting tobacco (79.9%). Less than half the sample (47.1%) referred patients to tobacco quitting services/programs. Male gender (Adjusted odds ratio (AOR) 5.50, 95% CI 2.48−12.23, p < 0.001), having a tobacco user at home/the workplace (AOR 3.18, 95% CI 1.57−6.45, p 0.001), and believing that tobacco cessation counseling was a waste of time (AOR 2.32, 95% CI 1.13−4.76, p 0.021) were associated with significantly increased odds of tobacco use among dental professionals. The study concluded that tobacco use was common among dental professionals despite their awareness of the adverse effects of tobacco. Reduction in tobacco use and promotion of counseling skills among dental professionals should be achieved through public health measures.

Incidence and prevalence of pulmonary tuberculosis among patients with type 2 diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

The epidemic of type 2 diabetes mellitus (T2DM) poses a great challenge to pulmonary tuberculosis (PTB) control. However, the incidence and prevalence of PTB among T2DM patients has not been fully determined. This meta-analysis aimed to provide the estimation on the global incidence and prevalence of PTB among T2DM patients (T2DM-PTB).

METHODS

Online databases including Web of Science, PubMed, China National Knowledge Infrastructure and Cochrane Library were searched for all relevant studies that reported the incidence or prevalence of T2DM-PTB through 31 January 2022. Pooled incidence and prevalence of T2DM-PTB with 95% confidence interval (CI) was estimated by the random-effect model. All statistical analyses were performed using R software.

RESULTS

A total of 24 studies (14 cohort studies, 10 cross-sectional studies) were included. The pooled incidence and prevalence of T2DM-PTB were 129.89 per 100,000 person-years (95% confidence interval (CI): 97.55-172.95) and 511.19 per 100,000 (95% CI: 375.94-695.09), respectively. Subgroup analyses identified that the incidence of T2DM-PTB was significantly higher in Asia (187.20 per 100,000 person-years, 95% CI: 147.76-237.17), in countries with a high TB burden (172.04 per 100,000 person-years, 95% CI: 122.98-240.68) and in studies whose data collection ended before 2011 (219.81 per 100,000 person-years, 95% CI: 176.15-274.28), but lower in studies using International Classification of Diseases-10 codes (73.75 per 100,000 person-years, 95% CI: 40.92-132.91). The prevalence of T2DM-PTB was significantly higher in countries with a high TB burden (692.15 per 100,000, 95% CI: 468.75-1022.04), but lower in Europe (105.01 per 100,000, 95% CI: 72.55-151.98).

CONCLUSIONS

This systematic review and meta-analysis suggests high global incidence and prevalence of PTB among T2DM patients, underlining the necessity of more preventive interventions among T2DM patients especially in countries with a high TB-burden. Key messagesA total of 24 studies (14 cohort studies, 10 cross-sectional studies) containing 2,569,451 T2DM patients were included in this meta-analysis.The pooled incidence and prevalence of T2DM-PTB are 129.89 per 100,000 person-years (95% CI: 97.55-172.95) and 511.19 per 100,000 (95% CI: 375.94-695.09) respectively.The incidence of T2DM-PTB was significantly higher in Asia, in countries with a high TB burden and in studies whose data collection ended before 2011, but lower in studies using International Classification of Diseases-10 codes.The prevalence of T2DM-PTB was significantly higher in countries with a high TB-burden, but lower in Europe.

Prevalence of cardiovascular risk factors in active tuberculosis in Africa: a systematic review and meta-analysis

People with tuberculosis (TB) are at risk of major adverse cardiovascular events. We estimated the prevalence of cardiovascular risk (CVR) factors among people with active TB in Africa. This was a systematic review and meta-analysis of studies from Africa. We searched EMBASE, MEDLINE through PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, mRCTs, Clinical trials.gov, and International Clinical Trials Registry Platform from inception to 31st December 2021. Among 110 eligible studies, 79 (238,316 participants) were included in the meta-analysis for smoking, 67 (52,793 participants) for current alcohol use, 30 (31,450 participants) for hazardous alcohol use, 51 (37,879 participants) for diabetes mellitus (DM), 19 (18,211 participants) for hypertension and 18 (13,910 participants) for obesity. The pooled prevalence was 26.0% (95% confidence interval 22.0–29.0) for smoking, 30.0% (25.0–35.0) for any current alcohol use, 21.0% (17.0–26.0) for hazardous alcohol use, 14.0% (9.0–18.0) for hypertension, 7.0% (6.0–9.0) for DM, and 4.0% (2.0–5.0) for obesity. Cost-effective strategies are needed to screen for CVR factors among people with active TB in Africa.

No smoke without fire: the impact of cigarette smoking on the immune control of tuberculosis

Cigarette smoke (CS) exposure is a key risk factor for both active and latent tuberculosis (TB). It is associated with delayed diagnosis, more severe disease progression, unfavourable treatment outcomes and relapse after treatment. Critically, CS exposure is common in heavily populated areas with a high burden of TB, such as China, India and the Russian Federation. It is therefore prudent to evaluate interventions for TB while taking into account the immunological impacts of CS exposure. This review is a mechanistic examination of how CS exposure impairs innate barrier defences, as well as alveolar macrophage, neutrophil, dendritic cell and T-cell functions, in the context of TB infection and disease.

Tuberculosis Predictive Index for Type 2 Diabetes Mellitus Patients Based on Biological, Social, Housing Environment, and Psychological Well-Being Factors

Indonesia is currently undergoing an epidemiological transition, with the double burden of disease due to increasing industrialization and urbanization leading to an increase in the prevalence of non-communicable diseases such as obesity and diabetes. On the other hand, the prevalence of infectious diseases such as tuberculosis remains high. Several factors were considered as risk factors in tuberculosis coincidence with type 2 diabetes mellitus. The purpose of this study was to develop a predictive index for tuberculosis in type 2 diabetes mellitus patients based on their biological, social, and environmental factors, and their psychological well-being as well. This case-control study involved 492 respondents consisting of 246 type 2 diabetes mellitus patients The variables studied were biological and social factors, the quality of their housing, and psychological well-being. Data analysis was conducted using a logistic regression test. The results showed that the predictive index formula was as follows: −3.218 + 0.867 × age + 1.339 × sex + 1.493 × history of contact with previous patient + 1.089 × glycemic control + 1.622 × tuberculosis clinical symptoms + 1.183 × body mass index + 0.891 × duration of diabetes mellitus + 0.454 × area of ventilation + 0.583 × psychological well-being. It is suggested that health workers, especially in primary health care facilities, will be able to increase the awareness of the risk of the coincidence of diabetes mellitus with tuberculosis.

Data Mining for ICD-10 Admission Diagnoses Preceding Tuberculosis within 1 Year among Non-HIV and Non-Diabetes Patients

Delayed diagnosis of tuberculosis (TB) increases mortality and extends the duration of disease transmission. This study aimed to identify significant ICD-10 admission diagnoses preceding TB. All hospital electronic medical records from fiscal year 2015 to 2020 in the Songkhla Province, Thailand were retrieved. After excluding diabetes and HIV patients, a case-control analysis was performed. Exposures of interest were ICD-10 diagnoses on admissions 1–12 months prior to the visit during which TB was detected. Incident cases of respiratory tuberculosis (A15.0–A16.9) that had been admitted with at least one such exposure were chosen. For every case, controls were retrieved from weekly concurrent OPD patients who had the same 10-year interval of age, sex, and preceding admission and discharge week as the case. The 10 most common comorbidities during hospitalization preceding TB with their relative odds ratios (RORs) and 95% confidence intervals were identified. These included five significant exposures related to lower respiratory infection without adequate TB investigation. Significant RORs ranged from 3.10 (unspecified pneumonia) to 34.69 (hemoptysis). Full TB investigation was not performed due to problems with health insurance. In conclusion, the physicians should be informed about this pitfall, and the insurance system should be revised accordingly.

Tuberculosis prevalence and associated factors among persons with diabetes mellitus after intensified case finding in three West African countries

Background

To determine the prevalence of tuberculosis (TB) and associated factors in persons with diabetes mellitus (DM) in Benin, Guinea and Senegal.

Patients and Method

A cross-sectional study was conducted in the largest DM center in each country. Participants systematically underwent clinical screening and chest radiography. Participants who were symptomatic or with abnormal radiography underwent bacteriological investigations (sputum smear, Xpert MTB/RIF and culture) on sputum. Participants with no TB at enrolment were re-examined for TB six months later. Logistic regression was performed to identify factors associated with TB.

Results

There were 5,870 DM patients: 1,881 (32.0%) in Benin, 1,912 (32.6%) in Guinea and 2,077 (35.4%) in Senegal. Out of these, 114 had bacteriologically-confirmed TB, giving a pooled prevalence of 1.9% (95%CI=1.6-2.3). TB prevalence was 0.5% (95%CI=0.3-1.0), 2.4% (95%CI=1.8-3.2) and 2.8% (95%CI=2.2-3.6), respectively, in Benin, Guinea and Senegal. Factors associated with an increased odds of TB diagnosis were a usual residence in Guinea (aOR=2.62;95%CI=1.19-5.77; p=0.016) or in Senegal (aOR=3.73;95%CI=1.85-7.51; p<0.001), the age group of 35-49 years (aOR=2.30;95%CI=1.11-4.79; p=0.025), underweight (aOR=7.34;95%CI=4.65-11.57; p<0.001) and close contact with a TB case (aOR=2.27;95%CI=1.37-3.76; p=0.002). Obesity was associated with lower odds of TB (aOR=0.20; 95%CI=0.06-0.65; p=0.008).

Conclusion

TB is prevalent among DM patients in Benin, Guinea and Senegal and higher than among the general population. The findings support the need for intensified case finding in DM patients in order to ensure systematic early detection of TB during the routine consultation process.

The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice

Diabetes Mellitus increases the risk of developing Tuberculosis (TB) disease by about three times; it also doubles the risk of death during TB treatment and other poor TB treatment outcomes. Diabetes may increase the risk of latent infection with Mycobacterium tuberculosis (LTBI), but the magnitude of this effect is less clear. Whilst this syndemic has received considerable attention, most of the published research has focussed on screening for undiagnosed diabetes in TB patients or observational follow-up of TB treatment outcomes by diabetes status. There are thus substantial research and policy gaps, particularly with regard to prevention of TB disease in people with diabetes and management of patients with TB-diabetes, both during TB treatment and after successful completion of TB treatment, when they likely remain at high risk of TB recurrence, mortality from TB and cardiovascular disease. Potential strategies to prevent development of TB disease might include targeted vaccination programmes, screening for LTBI and preventive therapy among diabetes patients or, perhaps ideally, improved diabetes management and prevention. The cost-effectiveness of each of these, and in particular how each strategy might compare with targeted TB prevention among other population groups at higher risk of developing TB disease, is also unknown. Despite research gaps, clinicians urgently need practical management advice and more research evidence on the choice and dose of different anti-diabetes medication and effective medical therapies to reduce cardiovascular risks (statins, anti-hypertensives and aspirin). Substantial health system strengthening and integration may be needed to prevent these at risk patients being lost to care at the end of TB treatment.

Evaluation of computer aided detection of tuberculosis on chest radiography among people with diabetes in Karachi Pakistan

Pakistan ranks fifth among high tuberculosis (TB) burden countries and also has seventh highest burden for diabetes mellitus (DM). DM increases the risk of developing TB and contributes to adverse TB treatment outcomes hence screening and integrated management for both diseases in high burden countries is suggested. Computer-Aided Detection for TB (CAD4TB) can potentially be used as triage tool in low resource settings to pre-screen individuals for Xpert MTB/RIF testing. The aim of this study was to evaluate the diagnostic accuracy and performance of CAD4TB software in people with diabetes (PWD) enrolled in a TB screening program in Karachi, Pakistan. A total of 694 individuals with a diagnosis of DM (of whom 31.1% were newly diagnosed) were screened with CAD4TB and simultaneously provided sputum for Xpert MTB/RIF testing. Of the 74 (10.7%) participants who had bacteriologically positive (MTB+) results on Xpert testing, 54 (73%) had a CAD4TB score >70; and 155 (25%) participants who tested MTB-negative had scores >70. The area under the receiver operator curve was 0.78 (95% CI: 0.77-0.80). Our study findings indicate that CAD4TB offers good diagnostic accuracy as a triage test for TB screening among PWD using Xpert MTB/RIF as the reference standard.

Diabetes Mellitus and Tuberculosis Comorbidity and Associated Factors Among Bale Zone Health Institutions, Southeast Ethiopia

BACKGROUND

Globally, tuberculosis and diabetes mellitus co-morbidity is higher than tuberculosis and human immunodeficiency virus comorbidity. Considering this, the World Health Organization and the International Union against tuberculosis and lung disease recommend bi-directional screening of the two diseases. However, in Ethiopia, bi-directional screening has not been started yet.

OBJECTIVE

The objective of this study was to assess the prevalence of diabetes mellitus and tuberculosis comorbidity and its predictors among adult tuberculosis patients in Bale Zone Health Institutions, Southeastern Ethiopia.

MATERIALS AND METHODS

Institutional-based cross-sectional study carried out using interviewer administered questionnaire, registration review, anthropometric and blood glucose level measurement from March, 30, 2019 to April, 30, 2019. Three hundred twenty-one tuberculosis patients were selected from tuberculosis registration log book using lottery methods. The collected data were checked for completeness, coded and entered in to EpiData3.0.2 and exported to SPSS version 20. Independent variables that had p value less 0.25 were used as candidates for multiple logistic regressions to control confounders. Variables that had significant association were identified by calculating odds ratio, with 95% confidence interval, and p value less than 0.05 used to declare statistical significance.

RESULTS

Diabetes mellitus and tuberculosis comorbidity among adult tuberculosis patients was 5.1% (95% CI: 2.7%, 7.5%). Age with ≥50 years (AOR=3.98, 95% CI: 1.13, 14.36), having extra pulmonary tuberculosis (AOR=3.31, 95% CI: 1.16, 9.44) and being females (AOR=3.8, 95% CI: 1.17, 12.33) were significantly associated with the comorbidity of the two diseases.

CONCLUSION AND RECOMMENDATION

The prevalence of diabetes mellitus and tuberculosis comorbidity was high. Female tuberculosis patients, tuberculosis patients with age ≥50 years and those having extra pulmonary tuberculosis patients should be screened for diabetes mellitus.

The epidemiology of intransient TB-induced hyperglycaemia in previously undiagnosed diabetes mellitus 2 individuals: a protocol for a systematic review and meta-analysis

BACKGROUND

Diabetes mellitus (DM) is burgeoning as a global chronic health condition. Some studies suggest that tuberculosis (TB) can even cause diabetes in those not previously known to be diabetic, which as a corollary can add to the already heavy global DM burden. The World Health Organization (WHO) recommends screening for DM at the start of TB treatment; however, it remains to be elucidated which patients with TB-induced hyperglycaemia are at risk for developing DM and who would benefit from a more regular follow-up. This systematic review will aim to firstly synthesise literature on the irreversibility of TB-induced hyperglycaemia in individuals with previously undiagnosed type 2 diabetes mellitus and secondly to synthesise literature on risk factors for progression from TB-induced hyperglycaemia to overt DM in previously undiagnosed.

METHODS

We will search for relevant studies in electronic databases such as PubMed, EMBASE, PROQUEST, and SCOPUS. Furthermore, references will be hand searched to identify other studies. A flow diagram will be drawn to identify the studies retrieved from each database. We will review all publications that include studies containing data on impaired glucose metabolism upon TB diagnosis, and the quality of all eligible studies will be assessed using the Newcastle-Ottawa Scale. We will further conduct a meta-analysis to pool estimates on the risk of progression of persistent hyperglycaemia to overt DM within this population group, as well as the risk factors for this progression. We will use a random effect model to assess heterogeneity, will carry out sensitivity analysis to explore the influence of a single study on the overall estimate, and will report our findings from our systematic review and meta-analysis according to PRISMA guidelines. Egger's test will be performed to explore the presence of selective reporting bias. If data allow, we will perform a subgroup/meta-regression analysis. Summary effects will be reported using odds ratio, hazard ratio, and relative risk ratios. Furthermore, any clinical, epidemiological, and public health research gaps we identify will be described in a research proposal.