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Baral T, M SS, Thomas L, B RA, Krishnan K, Shetty S, Rao M. Isoniazid-induced pancreatitis: A systematic review. Tuberculosis (Edinb) 2024; 148:102535. [PMID: 38941909 DOI: 10.1016/j.tube.2024.102535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/17/2024] [Accepted: 06/24/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND Isoniazid-induced pancreatitis is a potentially serious adverse drug reaction, however, the frequency of its occurrence is unknown. We conducted a systematic review to explore this adverse drug reaction comprehensively. METHODS We performed an advanced search in PubMed, Web of Science, Scopus, Ovid, and Embase for studies that reported isoniazid-induced pancreatitis. From the extracted data of eligible cases, we performed a descriptive analysis and a methodological risk of bias assessment using a standardized tool. RESULTS We included 16 case reports from eight countries comprising 16 patients in our systematic review. Most of the isoniazid-induced pancreatitis cases were extrapulmonary tuberculosis cases. We found the mean age across all case reports was 36.7 years. In all the cases, discontinuation of isoniazid resulted in the resolution of pancreatitis. CONCLUSIONS We found the latency period for isoniazid-induced pancreatitis to be ranged from 12 to 45 days after initiation of isoniazid therapy. A low threshold for screening of pancreatitis by measuring pancreatic enzymes in patients on isoniazid presenting with acute abdominal pain is recommended. This would facilitate an early diagnosis and discontinuation of isoniazid, thus reducing the severity of pancreatitis and preventing the complications of pancreatitis.
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Affiliation(s)
- Tejaswini Baral
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
| | - Sonal Sekhar M
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
| | - Levin Thomas
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
| | - Roopa Acharya B
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
| | - Keerthana Krishnan
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
| | - Sahana Shetty
- Department of Endocrinology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
| | - Mahadev Rao
- Department of Pharmacy Practice, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, 576104, Karnataka, India.
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Hullalli R, Gudadinni MR, Motappa R. A cross-sectional observational study to assess socio-demographic factors in newly diagnosed TB DM comorbidity. F1000Res 2024; 11:674. [PMID: 38779466 PMCID: PMC11109703 DOI: 10.12688/f1000research.122471.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2024] [Indexed: 05/25/2024] Open
Abstract
Background Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is one of the rising public health problems. There is growing evidence that DM is an important risk factor for TB. This study was carried out to know the prevalence of DM among newly detected sputum positive pulmonary TB patients registered in District Tuberculosis Centre and to assess the risk factors of DM among TB patients. Methods In a cross-sectional study, newly detected sputum positive pulmonary TB patients were screened for DM (those having symptoms of DM). Furthermore, they were diagnosed by detecting blood glucose levels (≥200 mg/dL). Mean, standard deviation (SD), Chi-squared and Fisher-Freeman-Halton exact tests were used to determine the significant associations. P-values less than 0.05 were considered to be statistically significant. Results A total of 215 TB patients were included in this study. The prevalence of DM among TB patients was found to be 23.7% (2.8% known and 97.8% new cases). Significant associations were found between age (>46 years old), educational status, smoking habits, alcohol consumption, physical activity, presence of DM symptoms and family history of DM. Conclusions Routine screening for DM is mandatory due to its increasing prevalence, which may help in early diagnosis and to reduce complications by proper management that in turn helps in the successful outcome of TB treatment.
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Affiliation(s)
- Rashmi Hullalli
- Department of Community Medicine, Shri B M Patil Medical College, Vijayapura, Karnataka, 586103, India
| | - M R Gudadinni
- Department of Community Medicine, Shri B M Patil Medical College, Vijayapura, Karnataka, 586103, India
| | - Rohith Motappa
- Department of Community Medicine, Kasturba Medical College Hospital, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Vaishya R, Misra A, Vaish A, Singh SK. Diabetes and tuberculosis syndemic in India: A narrative review of facts, gaps in care and challenges. J Diabetes 2024; 16:e13427. [PMID: 37292055 PMCID: PMC11070841 DOI: 10.1111/1753-0407.13427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/10/2023] Open
Abstract
Both diabetes mellitus (DM) and tuberculosis (TB) are prevalent all across in India. TB-DM comorbidity has emerged as a syndemic and needs more attention in India considering gaps in screening, clinical care, and research. This paper is intended to review published literature on TB and DM in India to understand the burden of the dual epidemic and its trajectory and to obtain perspectives on the gaps, constraints, and challenges in care and treatment of this dual epidemic. A literature search was carried out on PubMed, Scopus, and Google Scholar, using the key words 'Tuberculosis' OR 'TB' AND 'Diabetes' OR 'Diabetes Mellitus' AND 'India', focusing on the research published between the year 2000 to 2022. The prevalence of DM is high in patients with TB. Quantitative data on the epidemiological situation of TB/DM in India such as incidence, prevalence, mortality, and management are lacking. During the last 2 years convergence of TB-DM syndemic with the COVID-19 pandemic has increased cases with uncontrolled DM but also made coordinated control of TB-DM operationally difficult and of low effectiveness. Research regarding TB-DM comorbidity is required in the context of epidemiology and management. Detection and bidirectional screening are aggressively warranted. Management of DM in those with TB-DM comorbidity needs more efforts, including training and supervision of frontline workers.
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Affiliation(s)
- Raju Vaishya
- Department of Orthopaedics and Joint Replacement SurgeryIndraprastha Apollo HospitalsNew DelhiIndia
| | - Anoop Misra
- Fortis‐C‐DOC Centre of Excellence for DiabetesMetabolic Diseases and EndocrinologyNew DelhiIndia
- National Diabetes, Obesity and Cholesterol Foundation (N‐DOC)New DelhiIndia
- Diabetes Foundation (India) (DFI)New DelhiIndia
| | - Abhishek Vaish
- Department of Orthopaedics and Joint Replacement SurgeryIndraprastha Apollo HospitalsNew DelhiIndia
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Pati S, van den Akker M, Schellevis FFG, Sahoo KC, Burgers JS. Management of diabetes patients with comorbidity in primary care: a mixed-method study in Odisha, India. Fam Pract 2023; 40:714-721. [PMID: 36610706 DOI: 10.1093/fampra/cmac144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Diabetes patients with comorbidities need regular and comprehensive care for their disease management. Hence, it is essential to assess the primary care preparedness for managing diabetes patients and the perspectives of the diabetes patients on the care received at the primary care facilities. METHODS All 21 Urban Primary Health Centres (UPHCs) in Bhubaneswar city of Odisha, India, were assessed using the modified Primary Care Evaluation Tool and WHO Package of Essential Non-communicable disease interventions questionnaire. Additionally, 21 diabetes patients with comorbidities were interviewed in-depth to explore their perception of the care received at the primary care facilities. RESULTS All the UPHCs had provisions to meet the basic requirements for the management of diabetes and common comorbidities like hypertension. There were few provisions for chronic kidney illness, cardiovascular disease, mental health, and cancer. Diabetes patients felt that frequent change in primary care physicians at the primary care facilities affected their continuity of care. Easy accessibility, availability of free medicines, and provisions of basic laboratory tests at the facilities were felt to be necessary by the diabetes patients. CONCLUSION Our study highlights the existing gaps in India's healthcare system preparedness and the needs of diabetes patients with comorbidity. The government of India's Health and Wellness (HWC) scheme aims to deliver comprehensive healthcare to the population and provide holistic care at the primary care level for NCD patients. It is imperative that there is an early implementation of the various components of the HWC scheme to provide optimal care to diabetes patients.
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Affiliation(s)
- Sandipana Pati
- Department of Health and Family Welfare, Government of Odisha, Orissa State Institute of Health and Family Welfare, Bhubaneswar, India
| | - Marjan van den Akker
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Family Medicine, Goethe-Universität Frankfurt am Main Institut für Allgemeinmedizin, Frankfurt, Germany
- Katholieke Universiteit Leuven Academisch Centrum voor Huisartsgeneeskunde, Leuven, Belgium
- Department of General Practice & Elderly Care Medicine, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - F François G Schellevis
- Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Family Medicine, Goethe-Universität Frankfurt am Main Institut für Allgemeinmedizin, Frankfurt, Germany
- Katholieke Universiteit Leuven Academisch Centrum voor Huisartsgeneeskunde, Leuven, Belgium
- Department of General Practice & Elderly Care Medicine, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
- Department of General Practice & Elderly Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Krushna Chandra Sahoo
- Health Technology Assessment in India (HTAIn), ICMR-Regional Medical Research Centre, Bhubaneswar, India
| | - Jako S Burgers
- Department of Family Medicine, School CAPRI, Maastricht University, Maastricht, The Netherlands
- Dutch College of General Practitioners, Utrecht, The Netherlands
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Rehman AU, Khattak M, Mushtaq U, Latif M, Ahmad I, Rasool MF, Shakeel S, Hayat K, Hussain R, Alhazmi GA, Alshomrani AO, Alalawi MI, Alghamdi S, Imam MT, Almarzoky Abuhussain SS, Khayyat SM, Haseeb A. The impact of diabetes mellitus on the emergence of multi-drug resistant tuberculosis and treatment failure in TB-diabetes comorbid patients: a systematic review and meta-analysis. Front Public Health 2023; 11:1244450. [PMID: 38074769 PMCID: PMC10704033 DOI: 10.3389/fpubh.2023.1244450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 10/24/2023] [Indexed: 12/18/2023] Open
Abstract
Background The existence of Type 2 Diabetes Mellitus (DM) in tuberculosis (TB) patients is very dangerous for the health of patients. One of the major concerns is the emergence of MDR-TB in such patients. It is suspected that the development of MDR-TB further worsens the treatment outcomes of TB such as treatment failure and thus, causes disease progression. Aim To investigate the impact of DM on the Emergence of MDR-TB and Treatment Failure in TB-DM comorbid patients. Methodology The PubMed database was systematically searched until April 03, 2022 (date last searched). Thirty studies met the inclusion criteria and were included in this study after a proper selection process. Results Tuberculosis-Diabetes Mellitus patients were at higher risk to develop MDR-TB as compared to TB-non-DM patients (HR 0.81, 95% CI: 0.60-0.96, p < 0.001). Heterogeneity observed among included studies was moderate (I2 = 38%). No significant change was observed in the results after sub-group analysis by study design (HR 0.81, 95% CI: 0.61-0.96, p < 0.000). In the case of treatment failure, TB-DM patients were at higher risk to experience treatment failure rates as compared to TB-non-DM patients (HR 0.46, 95% CI: 0.27-0.67, p < 0.001). Conclusion The results showed that DM had a significant impact on the emergence of MDR-TB in TB-diabetes comorbid patients as compared to TB-non-DM patients. DM enhanced the risk of TB treatment failure rates in TB-diabetes patients as compared to TB-non-DM patients. Our study highlights the need for earlier screening of MDR-TB, thorough MDR-TB monitoring, and designing proper and effective treatment strategies to prevent disease progression.
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Affiliation(s)
- Anees ur Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Mahnoor Khattak
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Usman Mushtaq
- Nishter Medical University and Hospital, Multan, Pakistan
| | - Muhammad Latif
- Department of Zoology, Division of Science and Technology, University of Education Lahore, Lahore, Pakistan
| | - Imran Ahmad
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Sadia Shakeel
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Dow University of Health Sciences, Karachi, Pakistan
| | - Khezar Hayat
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Rabia Hussain
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Ghaidaa Ali Alhazmi
- Department of Pharmacy, King Abdullah Medical City, Ministry of Health, Makkah, Saudi Arabia
| | - Afnan Owedah Alshomrani
- Pharmaceutical Care Department, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Jeddah, Saudi Arabia
| | | | - Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Al-Baha University, Al-Baha, Saudi Arabia
| | - Mohammad Tarique Imam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | | | - Sarah M. Khayyat
- Department of Pharmacy Practice, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Abdul Haseeb
- Department of Pharmacy Practice, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
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Chandru BA, Varma RP. Factors affecting ability of TB patients to follow treatment guidelines - applying a capability approach. Int J Equity Health 2023; 22:176. [PMID: 37658369 PMCID: PMC10474720 DOI: 10.1186/s12939-023-01991-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/15/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Negotiating anti-Tuberculosis treatment is a complicated process comprising daily consumption of multiple medications at stipulated times and dosages, as well as periodic follow-ups and investigations, may not be uniform for all Tuberculosis (TB) patients and some may perform better than others. In this context, we conducted a study in Thiruvananthapuram district, Kerala to ascertain the ability of those suffering from TB to follow treatment guidelines. METHODS This study used an embedded mixed methods design. We collected cross-sectional data from 135 drug sensitive pulmonary TB patients aged 18 years or above in Thiruvananthapuram, Kerala using a structured questionnaire to get the proportion of patients following all treatment guidelines. We also did eight in-depth interviews (four men and four women) from within the survey sample. The in-depth interviews were inductively analysed for getting deeper insights about reasons for the choices people made regarding the treatment guidelines. Written informed consent was taken from all participants and the study was implemented after the necessary programmatic and ethical clearances. RESULTS Of the 105 men and 30 women studied, uninterrupted daily drug consumption was reported by 80 persons (59.3%, 95% Confidence Intervals (CI) 50.8-67.2%). Overall, 38 (28.2%, 95% CI 21.3%-36.3%) persons were able to follow all seven aspects of advised guidelines. Living in an extended/ joint family (Adjusted Odds ratio (AOR) 2.6, 95% CI 1.1-6.0), approximate monthly household expenditure of over rupees 13,500 (AOR 2.9, 95% CI 1.3-6.7) and no perceived delay in seeking initial care (AOR 3.2, 95% CI 1.2-8.7) were significantly associated with following all aspects of treatment guidelines. In-depth interviews revealed reflective treatment related behaviours were influenced by bodily experiences, moral perceptions, social construct of TB, programmatic factors and substance use. Sometimes behaviours were non-reflective also. Programmatic stress was on individual agency for changing behaviour but capability and opportunity for these were influenced social aspects like stigma, gender roles and poverty. CONCLUSION TB patients live amidst a syndemic of biomedical and social problems. These problems influence the capabilities and opportunities of such TB patients to follow treatment guidelines. Interventions should balance focus on individual agency and social abd economic factors.
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Affiliation(s)
- B Aravind Chandru
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Medical College Post Office, Thiruvananthapuram, Kerala, India
| | - Ravi Prasad Varma
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Medical College Post Office, Thiruvananthapuram, Kerala, India.
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Guo J, Liu ZD, Feng YP, Luo SR, Jiang QM. Assessment of Effective Anti-TB Regimens and Adverse Outcomes Related Risk Factors in the Elderly and Senile-Aged TB Patients. Infect Drug Resist 2023; 16:3903-3915. [PMID: 37361933 PMCID: PMC10289104 DOI: 10.2147/idr.s414918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Objective Compared to younger patients with tuberculosis (TB), elderly and senile-aged patients with TB had a higher incidence of adverse outcomes particularly in terms of lost to follow-up and deaths. Our study aimed to gain insight into the effectiveness of anti-tuberculosis (anti-TB) treatment in the elderly or senile-aged patients and identify the risk factors for adverse outcomes. Methods The case information was obtained from the "Tuberculosis Management Information System". From January 2011 to December 2021, this retrospective analysis was conducted in Lishui City, Zhejiang Province to observe and record the outcomes of elderly patients diagnosed with TB who agreed to receive anti-TB and(or) traditional Chinese medicine(TCM) treatment. We also employed a logistic regression model to analyze the risk factors for adverse outcomes. Results Among the 1191 elderly or senile-aged patients with TB who received the treatment, the success rate was 84.80% (1010/1191). Using logistic regression analysis, several risk factors for adverse outcomes (failure, death, loss to follow-up) were identified, including age ≥ 80 years (OR 2.186, 95% CI 1.517~3.152, P<0.001), lesion area ≥ 3 lung fields (OR 0.410, 95% CI 0.260~0.648, P<0.001), radiographic lesions failing to improve after 2 months of treatment (OR 2.048, 95% CI 1.302~3.223, P=0.002), sputum bacteriology failing to turn negative after 2 months of treatment (OR 2.213, 95% CI 1.227~3.990, P=0.008), lack of a standardized treatment plan (OR 2.095, 95% CI 1.398~3.139, P<0.001), and non-involvement of traditional Chinese medicine (OR 2.589, 95% CI 1.589~4.216, P<0.001). Conclusion The anti-TB treatment success rate in the elderly and senile-aged patients is suboptimal. Contributing factors include advanced age, extensive lesions, and low sputum negative conversion rate during the intensive treatment phase. The results will informative and could be useful for policy maker for to control of reemergence of TB in big cities.
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Affiliation(s)
- Jing Guo
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, 323000, People’s Republic of China
| | - Zhong-Da Liu
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, 323000, People’s Republic of China
| | - Yin-Ping Feng
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, 323000, People’s Republic of China
| | - Shui-Rong Luo
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, 323000, People’s Republic of China
| | - Qiao-Min Jiang
- Department of Tuberculosis, Lishui Hospital of Traditional Chinese Medicine, Lishui, 323000, People’s Republic of China
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Kibirige D, Zawedde-Muyanja S, Andia-Biraro I, Olum R, Adakun S, Sekaggya-Wiltshire C, Kimuli I. Diagnostic accuracy of two confirmatory tests for diabetes mellitus in adult Ugandans with recently diagnosed tuberculosis. Ther Adv Infect Dis 2023; 10:20499361231216799. [PMID: 38145193 PMCID: PMC10748612 DOI: 10.1177/20499361231216799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/08/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The optimal confirmatory tests for diabetes mellitus (DM) in patients with tuberculosis (TB) vary across populations. This study aimed to evaluate the performance of two confirmatory tests for DM against the oral glucose tolerance test (OGTT) as the reference test in adult Ugandans with recently diagnosed TB. Methods A total of 232 adult participants receiving TB treatment underwent initial screening for DM with random blood glucose (RBG) measurement. Participants with a RBG level ⩾6.1 mmol/l received additional screening with fasting blood glucose (FBG), laboratory-measured glycated haemoglobin (HbA1c) and an OGTT. Using the latter as the gold standard and reference test, we evaluated the diagnostic accuracy of laboratory-measured HbA1c and FBG. Results Of the 232 participants initially screened for DM using RBG measurement, 117 participants (50.4%) had RBG level ⩾6.1 mmol/l and were scheduled to return for additional blood glucose testing. Of these, 75 (64.1%) participants returned for FBG and HbA1c measurements. A diagnosis of DM was made in 32 participants, corresponding to a prevalence of 13.8% [95% CI 9.9-18.9].The areas under the curve (AUC) for FBG and laboratory-measured HbA1c were 0.69 [95% CI 0.47-0.90] and 0.65 [95% CI 0.43-0.87], respectively. The sensitivity and specificity of a FBG level of ⩾7 mmol/l were 57.1% [95% CI 18.4-90.1] and 74.6% [95% CI 62.5-84.5], respectively, whereas the sensitivity and specificity for laboratory-measured HbA1c of ⩾6.5 mmol/l (48 mmol/mol) were 14.3% [95% CI 0.40-57.9] and 95.3% (86.9-99.0%), respectively. Conclusion FBG may be better than laboratory-measured HbA1c in confirming DM in adult Ugandans with recently diagnosed TB. However, because of the small study sample size, larger studies evaluating the diagnostic utility of these diabetes screening tests in adult Ugandans with TB are needed to confirm these findings.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
- Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. BOX 14130 Kampala, Entebbe +256, Uganda
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Irene Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
| | - Susan Adakun
- Adult Tuberculosis Unit, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | | | - Ivan Kimuli
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
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Tireh H, Heidarian Miri H, Khajavian N, Samiei A, Afzalaghaee M. Prevalence of Diabetes Mellitus and its Related Factors in Patients with Tuberculosis. ARCHIVES OF IRANIAN MEDICINE 2022; 25:835-840. [PMID: 37543911 PMCID: PMC10685843 DOI: 10.34172/aim.2022.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/11/2021] [Indexed: 08/08/2023]
Abstract
BACKGROUND Considering the high prevalence of tuberculosis (TB) in developing countries and the fact that comorbidity with diabetes mellitus (DM) imposes a higher burden on the society, this study was carried out to assess the prevalence of diabetes and its related factors in patients with TB in Mashhad, Iran. METHODS In this study, we enrolled 405 patients over the age of 18 who had been diagnosed with TB between the years 2015 and 2016 according to the documents of the ministry of health. The participants were selected randomly from five health center domains based on the stratified sampling method. The patients were screened for diabetes according to HbA1c over 6.5% or a fasting blood sugar (FBS) level over 126 mg/dL at different time points and the patient's self-report of having DM. RESULTS The mean age of participants was 51.14±20.52 (19-92 years). The prevalence of DM in patients with TB was 21.2%, of whom 3.5% were newly diagnosed. Among potential factors, age with OR=3.786 (1.183, 12.113), body mass index with OR=9.149 (3.182, 26.302), nationality with OR=2.149 (1.122, 4.117) and TB type with 3.328 (1.44, 7.689) were associated with DM in patients with TB. CONCLUSION The prevalence of DM in our study was higher than that observed in other countries. Our study showed associated factors like age, body mass index, and TB type to be very important. Also, the prevalence of DM was different in patients with different nationality.
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Affiliation(s)
- Hossein Tireh
- Student Research Committee, Mashhad University of Medical Science, Mashhad, Iran
| | - Hamid Heidarian Miri
- Management & Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nasim Khajavian
- Instructor Social Determinants of Health Research Center, Gonabad University of Medical Science, Gonabad, Iran
| | - Amin Samiei
- Tuberculosis Coordinator at Health Department of Mashhad University of Medical Sciences, Mashhad, Iran
| | - Monavar Afzalaghaee
- Management & Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Sheuly AH, Arefin SMZH, Barua L, Zaman MS, Chowdhury HA. Prevalence of type 2 diabetes and pre‐diabetes among pulmonary and extrapulmonary tuberculosis patients of Bangladesh: A cross‐sectional study. Endocrinol Diabetes Metab 2022; 5:e00334. [PMID: 35261187 PMCID: PMC9094490 DOI: 10.1002/edm2.334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/02/2022] [Accepted: 02/26/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Afsana Habib Sheuly
- Helen Keller International Bangladesh Dhaka Bangladesh
- Department of Biostatistics Bangladesh University of Health Sciences (BUHS) Dhaka Bangladesh
| | | | - Lingkan Barua
- Department of Noncommunicable Diseases Bangladesh University of Health Sciences (BUHS) Dhaka Bangladesh
| | | | - Hasina Akhter Chowdhury
- Department of Biostatistics Bangladesh University of Health Sciences (BUHS) Dhaka Bangladesh
- Centre for Injury Prevention and Research Bangladesh Dhaka Bangladesh
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Anyanwu MO, Ajumobi OO, Afolabi NB, Usman A, Kehinde A. Diabetes mellitus and its associated factors among patients with tuberculosis attending directly observed treatment centres in Oyo State, Nigeria: a cross-sectional evaluation. BMJ Open 2022; 12:e059260. [PMID: 35365543 PMCID: PMC8977797 DOI: 10.1136/bmjopen-2021-059260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Diabetes mellitus (DM) and tuberculosis (TB) comorbidity is evolving into an emerging epidemic globally. In Nigeria, a high burden of both diseases, respectively, exists with limited information on tuberculosis-diabetes mellitus (TB-DM) comorbidity. We determined the fasting blood glucose (FBG) level among patients with TB and factors associated with TB-DM comorbidity in Oyo State, South-west Nigeria. METHODS A cross-sectional study was conducted among patients with TB aged 15 years and above, who were selected using multistage sampling. Data were collected on patients' biodata, anthropometric measurements and FBG levels using a pretested semistructured questionnaire. The FBG test was conducted on patients with confirmed pulmonary TB (old and newly diagnosed patients with TB) at any stage of anti-TB treatment. Background characteristics and FBG level were summarised using descriptive statistics and factors associated with TB-DM comorbidity were examined at bivariate and multivariable analyses. RESULTS Of the 404 patients with TB, 30 (7.4%) had impaired fasting glucose and 32 (7.9%) were diagnosed with diabetes. The mean age of the male and female respondents was 41 (±14.2) and 36.8 (±15.0), respectively. Females were more likely than males to have diabetes (10.6% vs 6.3%). Median FBG level for the patients was 88 (IQR: Q1: 99, Q3: 79) mg/dL. Age, marital status and educational level were not associated with TB-DM comorbidity. In the multivariable model, only normal body mass index was independently and significantly associated with diabetes. CONCLUSION TB-DM was prevalent among the studied population in South-west Nigeria. We recommend the integration of DM screening within the continuum of care for TB management.
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Affiliation(s)
| | - Olufemi O Ajumobi
- University of Nevada Reno School of Community Health Sciences, Reno, Nevada, USA
| | - Nathanael B Afolabi
- Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria
| | - Aishat Usman
- African Field Epidemiology Network Nigeria, Abuja, Nigeria
| | - Aderemi Kehinde
- Department of Medical Microbiology and Parasitology, College of Medicine, University of Ibadan, Ibadan, Nigeria
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12
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Byashalira KC, Chamba NG, Alkabab Y, Mbelele PM, Ntinginya NE, Ramaiya KL, Alimohamed MZ, Heysell SK, Mmbaga BT, Bygbjerg IC, Christensen DL, Mpagama SG, Lillebaek T. Clinical-demographic markers for improving diabetes mellitus diagnosis in people with tuberculosis in Tanzania. BMC Infect Dis 2022; 22:260. [PMID: 35296241 PMCID: PMC8925287 DOI: 10.1186/s12879-022-07249-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Tuberculosis (TB) control is threatened by an increasing prevalence of diabetes mellitus (DM), particularly in endemic countries. Screening for DM is not routinely implemented in Tanzania; therefore, we aimed to screen for DM at TB diagnosis using clinical-demographic markers. Methods Our cross-sectional study recruited TB patients who received anti-TB treatment between October 2019 and September 2020 at health care facilities in three regions from Tanzania. Patients were screened for DM using DM symptoms (polydipsia, polyphagia and polyuria) and random blood glucose (RBG) testing. Patients with a history of DM and those with no history of DM but an RBG ≥ 7.8 mmol/L had point-of-care glycated haemoglobin (HbA1c) testing, and were considered to have DM if HbA1c was ≥ 48 mmol/mol. Results Of 1344 TB patients, the mean age was 41.0 (± 17.0) years, and 64.7% were male. A total of 1011 (75.2%) had pulmonary TB, and 133 (10.4%) had at least one DM symptom. Overall, the prevalence of DM was 7.8%, of which 36 (2.8%) TB patients with no history of DM were newly diagnosed with DM by RBG testing. TB/DM patients were older than those with only TB (50.0 ± 14.0 years vs 40.0 ± 17.0 years, p < 0.001). Patients with RBG ≥ 7.8 mmol/L were more likely to have pulmonary TB (p = 0.003), age ≥ 35 years (p = 0.018), and have at least one DM symptom (p < 0.001). There was a substantial agreement (Kappa = 0.74) between the on-site glucometer and point-of-care HbA1c tests in detecting DM range of hyperglycemia. Conclusion The implementation of clinical-demographic markers and blood glucose screening identified the overall prevalence of DM and those at risk of DM in TB patients. Clinical-demographic markers are independent predictors for DM range hyperglycemia and highlight the importance of further diagnostic testing and early co-management of TB and DM.
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Affiliation(s)
- Kenneth Cleophace Byashalira
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania. .,Kibong'oto Infectious Diseases Hospital, Sanya Juu, P.O. Box: 12, Siha, Kilimanjaro, United Republic of Tanzania.
| | - Nyasatu Godfrey Chamba
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania
| | - Yosra Alkabab
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | - Peter Masunga Mbelele
- Kibong'oto Infectious Diseases Hospital, Sanya Juu, P.O. Box: 12, Siha, Kilimanjaro, United Republic of Tanzania
| | - Nyanda Elias Ntinginya
- National Institute of Medical Research, Mbeya Medical Research Centre, Mbeya, United Republic of Tanzania
| | | | - Mohamed Zahir Alimohamed
- Shree Hindu Mandal Hospital, Dar es Salaam, United Republic of Tanzania.,Department of Haematology and Blood Transfusion, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Scott Kirkland Heysell
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA
| | - Blandina Theophil Mmbaga
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania.,Kilimanjaro Christian Medical Centre, Moshi, United Republic of Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Ib Christian Bygbjerg
- Division Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Dirk Lund Christensen
- Division Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Stellah George Mpagama
- Kilimanjaro Christian Medical University College, Moshi, United Republic of Tanzania.,Kibong'oto Infectious Diseases Hospital, Sanya Juu, P.O. Box: 12, Siha, Kilimanjaro, United Republic of Tanzania
| | - Troels Lillebaek
- Division Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark
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13
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Gradient association between pulmonary tuberculosis and diabetes mellitus among households with a tuberculosis case: a contact tracing-based study. Sci Rep 2022; 12:1854. [PMID: 35115583 PMCID: PMC8814182 DOI: 10.1038/s41598-022-05417-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/30/2021] [Indexed: 11/09/2022] Open
Abstract
Pulmonary tuberculosis (PTB) and diabetes mellitus (DM) remain high morbidity and mortality, especially when they are comorbid with each other. Screening for diabetes mellitus in tuberculosis is essential as the incidence and mortality of DM in the population with PTB are higher than in the general people. We aimed to examine the gradient association of tuberculosis on developing DM, the additional yield and the number needed to screen (NNS) to find a new diabetes case. A cross-sectional study was conducted on 801 tuberculosis cases and 972 household contacts in Guizhou, China, from April 2019 to October 2020. After screening for PTB among contacts, all participants were screened for DM and interviewed. Kendall's tau-b test and proportional odds logistic regression analysis were applied to identify the gradient associations. Among the 1773 subjects, the additional yield of screening was 21.8%. The NNSs of the non-PTB group, the sputum-culture negative and positive groups were 50, 60 and 113, respectively. The gradient incremental establishment of DM and PTB were positively correlated. The general trend on the gradient of DM significantly increased with the gradient increase of PTB. Age 35 years and over, excessive edible oil intake and DM family history were identified as significant predictors of diabetes. Integrated screening for DM targeted to different gradients of PTB combined with associated factors is necessitated to achieve a higher additional yield.
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14
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Fazaludeen Koya S, Lordson J, Khan S, Kumar B, Grace C, Nayar KR, Kumar V, Pillai AM, Sadasivan LS, Pillai AM, Abdullah AS. Tuberculosis and Diabetes in India: Stakeholder Perspectives on Health System Challenges and Opportunities for Integrated Care. J Epidemiol Glob Health 2022; 12:104-112. [PMID: 35006580 PMCID: PMC8907360 DOI: 10.1007/s44197-021-00025-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background India has a dual burden of tuberculosis (TB) and diabetes mellitus (DM). Integrated care for TB/DM is still in the early phase in the country and can be considerably enhanced by understanding and addressing the challenges identified from stakeholders’ perspectives. This study explored the challenges and opportunities at individual, health system and policy level for integrated care of TB/DM comorbidities in India. Methods We used an outlier case study approach and conducted stakeholder interviews and focus group discussions with relevant program personnel including field staff and program managers of TB and DM control programs as well as officials of partners in Indian states, Kerala and Bihar. Results The integrated management requires strengthening the laboratory diagnosis and drug management components of the two individual programs for TB and DM. Focused training and sensitization of healthcare workers in public and private sector across all levels is essential. A district level management unit that coordinates the two vertical programs with a horizontal integration at the primary care level is the way forward. Substantial improvement in data infrastructure is essential to improve decision-making process. Conclusion Bi-directional screening and management of TB/DM comorbidities in India requires substantial investment in human resources, infrastructure, drug availability, and data infrastructure.
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Affiliation(s)
- Shaffi Fazaludeen Koya
- Global Institute of Public Health, Trivandrum, Kerala, India.,Boston University School of Public Health, Boston, MA, USA
| | - Jinbert Lordson
- Global Institute of Public Health, Trivandrum, Kerala, India.,Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India
| | - Salman Khan
- Global Institute of Public Health, Trivandrum, Kerala, India
| | - Binod Kumar
- Independent Public Health Consultant, Patna, Bihar, India
| | - Chitra Grace
- Global Institute of Public Health, Trivandrum, Kerala, India
| | | | - Vinod Kumar
- Global Institute of Public Health, Trivandrum, Kerala, India
| | - Anand M Pillai
- Global Institute of Public Health, Trivandrum, Kerala, India.,Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India
| | - Lal S Sadasivan
- Global Institute of Public Health, Trivandrum, Kerala, India
| | - A Marthanda Pillai
- Global Institute of Public Health, Trivandrum, Kerala, India.,Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India
| | - Abu S Abdullah
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu, China.
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15
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Alkabab YMA, Biswas S, Ahmed S, Paul K, Nagajyothi J, Banu S, Heysell S. Differentiating transient from persistent diabetic range hyperglycemia in a cohort of people completing tuberculosis treatment in Dhaka, Bangladesh. PLoS One 2021; 16:e0260389. [PMID: 34813631 PMCID: PMC8610235 DOI: 10.1371/journal.pone.0260389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/08/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In recent non-pandemic periods, tuberculosis (TB) has been the leading killer worldwide from a single infectious disease. Patients with DM are three times more likely to develop active TB and poor treatment outcomes. Single glycemic measurements at TB diagnosis may inaccurately diagnose or mischaracterize DM severity. Data are limited regarding glycemic dynamics from TB diagnosis through treatment. METHODS Prospective study of glycemia dynamics in response to TB treatment measured glycosylated haemoglobin (HbA1c) in patients presenting to TB screening centres in Bangladesh to determine the prevalence and risk factors of hyperglycemia before and at TB treatment completion. RESULTS 429 adults with active TB disease were enrolled and divided into groups based on history of DM and initial HbA1c range: normoglycemia, prediabetes, and DM. DM was diagnosed in 37%. At treatment completion,14(6%) patients from the normoglycemia and prediabetes groups had HbA1c>6.5%, thus increasing the prevalence of DM to 39%. The number needed to screen to diagnose one new case of DM at TB diagnosis was 5.7 and 16 at treatment completion in the groups without DM. Weight gain>5% at treatment completion significantly increased the risk of hyperglycemia in the groups without DM at TB diagnosis (95% CI 1.23-26.04, p<0.05). CONCLUSION HbA1c testing prior to and at TB treatment completion found a high prevalence of prediabetes and DM, including a proportion found at treatment completion and commonly in people with a higher percentage of weight gain. Further longitudinal research is needed to understand the effects of TB disease and treatment on insulin resistance and DM complications.
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Affiliation(s)
- Yosra M. A. Alkabab
- University of Virginia Medical Center, Division of Infectious diseases and International Health, Department of Medicine, Charlottesville, VA, United States of America
| | - Samanta Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Enteric and Respiratory Infections, Infectious Diseases Division, Dhaka, Bangladesh
| | - Shahriar Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Enteric and Respiratory Infections, Infectious Diseases Division, Dhaka, Bangladesh
| | - Kishor Paul
- The Kirby Institute, University of New South Wales, Surveillance Evaluation Research Program, Kensington, NSW, Australia
| | - Jyothi Nagajyothi
- Center for Discovery and Innovation, Hackensack University Medical Center, Nutley, New Jersey, United States of America
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Enteric and Respiratory Infections, Infectious Diseases Division, Dhaka, Bangladesh
| | - Scott Heysell
- University of Virginia Medical Center, Division of Infectious diseases and International Health, Department of Medicine, Charlottesville, VA, United States of America
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16
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Salifu RS, Hlongwa M, Hlongwana K. Implementation of the WHO's collaborative framework for the management of tuberculosis and diabetes: a scoping review. BMJ Open 2021; 11:e047342. [PMID: 34789489 PMCID: PMC8601079 DOI: 10.1136/bmjopen-2020-047342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To map evidence on the implementation of the WHO's collaborative framework for the management of tuberculosis (TB) and diabetes mellitus (DM) comorbidity, globally. DESIGN Scoping review. METHODS Guided by Arksey and O'Malley's scoping review framework, this review mapped literature on the global implementation of the framework for the management of TB and DM comorbidity, globally. An extensive literature search for peer-reviewed studies, theses, studies in the press and a list of references from the selected studies was conducted to source-eligible studies. PubMed, Google Scholar, Web of Science, Science Direct, the EBSCOhost platform (academic search complete, health source: nursing/academic edition, CINAHL with full text), Scopus and the WHO library were used to source the literature. We performed title screening of articles using keywords in the databases, after which two independent reviewers (RS and PV) screened abstracts and full articles. Studies from August 2011 to May 2021 were included in this review and the screening was guided by the inclusion and exclusion criteria. Findings were analysed using the thematic content analysis approach and results presented in the form of a narrative report. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension was used as a checklist and for explaining the scoping review process. RESULTS This review found evidence of the WHO TB-DM collaborative framework's implementation in 35 countries across the globe. TB-DM comorbidity was identified in patients through bidirectional screening of both patients with TB and patients with DM in rural and urban settings. CONCLUSION Due to the paucity of evidence on mechanisms of collaboration, we recommend further research in other implementing countries to identify techniques used for diagnosis and integration of TB and DM services, in order to ensure that effective and joint management of TB-DM comorbidity in populations is achieved.
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Affiliation(s)
- Rita Suhuyini Salifu
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
- Health and Development Solutions Network, Tamale, Ghana
| | - Mbuzeleni Hlongwa
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
- Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Khumbulani Hlongwana
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal College of Health Sciences, Durban, KwaZulu-Natal, South Africa
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17
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Murali S, Krishnamoorthy Y, Knudsen S, Roy G, Ellner J, Horsburgh CR, Hochberg N, Salgame P, Prakash Babu S, Sarkar S. Comparison of profile and treatment outcomes between elderly and non-elderly tuberculosis patients in Puducherry and Tamil Nadu, South India. PLoS One 2021; 16:e0256773. [PMID: 34449817 PMCID: PMC8396735 DOI: 10.1371/journal.pone.0256773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
The rising geriatric population and the increased susceptibility of this age group to tuberculosis (TB), the deadliest single infectious agent, is bothersome for India. This study tried to explore the demographic and treatment outcome differences between the elderly (aged 60 years and above) and non-elderly TB (<60 years) patients from South India. This study was part of a large ongoing cohort study under the RePORT India consortium. Newly diagnosed TB patients recruited into the cohort between 2014 and 2018 were included in this study. Pretested and standardized questionnaire and tools were used to collect data and were stored securely for the entire cohort. Required demographic, anthropometric and treatment related variables were extracted from this database and analyzed using Stata version 14.0. Prevalence of elderly TB was summarized as percentage with 95% confidence interval (CI). Generalized linear modelling was attempted to find the factors associated with elderly TB. A total of 1,259 eligible TB patients were included into this present study. Mean (SD) of the participants in the elderly and non-elderly group was 65.8 (6.2) and 40.2 (12.0) respectively. Prevalence of elderly TB was 15.6% (95%CI: 13.6%-17.6%) with nearly 71% belonging to 60–69 age category. Male sex, OBC caste, poor education, unemployment, marriage, alcohol consumption and unable to work as per Karnofsky score were found to be significantly associated with an increased prevalence of elderly TB. Unfavorable outcomes (12% vs 6.5%, p value: 0.018), including death (9.3% vs 3.4%, p value: 0.001) were significantly higher among the elderly group when compared to their non-elderly counterparts. The current TB programme should have strategies to maintain follow up with due attention to adverse effects, social support and outcomes. Additional research should focus on predictors for unfavorable outcomes among the elderly TB group and explore ways to handle the same. Rendering adequate social support from the health system side and family side would be a good start.
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Affiliation(s)
- Sharan Murali
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
| | | | - Selby Knudsen
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States of America
| | - Gautam Roy
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
| | - Jerrold Ellner
- Department of Medicine, Rutgers University, Newark, NJ, United States of America
| | - Charles Robert Horsburgh
- School of Public Health, Epidemiology & Biostatistics, Boston University, Boston, MA, United States of America
| | - Natasha Hochberg
- Section of Infectious Diseases, Boston University School of Medicine, Boston, MA, United States of America
| | - Padmini Salgame
- Department of Immunology, Rutgers University, Newark, NJ, United States of America
| | | | - Sonali Sarkar
- Department of Preventive & Social Medicine, JIPMER, Puducherry, India
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18
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Tulu B, Amsalu E, Zenebe Y, Abebe M, Fetene Y, Agegn M, Abate A, Ponpetch K, Bekana T, Gumi B, Ameni G. Diabetes mellitus and HIV infection among active tuberculosis patients in Northwest Ethiopia: health facility-based cross-sectional study. Trop Med Health 2021; 49:68. [PMID: 34454627 PMCID: PMC8403380 DOI: 10.1186/s41182-021-00358-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/20/2021] [Indexed: 12/04/2022] Open
Abstract
Background The prevalence of diabetes mellitus (DM) is increasing globally and its comorbidity with tuberculosis (TB) is re-emerging, especially in low- and middle-income countries. Objective The main aim of this study is to determine the prevalence of DM and HIV infection and their associated risk factors among active tuberculosis patients in Northwest Ethiopia. Methods This hospital-based cross-sectional study was conducted between February 1st and June 30th, 2017 among active TB patients in two hospitals of Northwest Ethiopia. Two hundred and sixty-seven active TB cases aged 18 years or older were screened for diabetes using fasting blood glucose (FBG) test. Semi-structured questionnaires were used to collect demographic data, lifestyle habits and clinical data. Identification of pre-diabetes or diabetes in TB patients was achieved according to American Diabetes Association guidelines (2016). Results Prevalence of DM and TB comorbidity was 11.5% (95% confidence interval, CI 7.8–15.2) compared to 24.9% (95% CI 20.1–30.1) for pre-diabetes. Prevalence of HIV/TB co-infection was 21.9% (95% CI 16.7–26.8). Risk of DM was higher in TB patients from a rural location (adjusted odds ratio, aOR 3.13, 95% CI 1.02–9.62, p = 0.046). Similarly, DM was higher in TB patients who have a family history of DM (aOR 4.54, 95% CI 1.31–15.68, p = 0.017). Furthermore, HIV/TB co-infection was identified as a predictor of DM comorbidity in active TB patients (aOR 5.11, 95% CI 2.01–12.98, p = 0.001). Conclusion The magnitude of DM and pre-diabetes in active TB patients in Northwest Ethiopia was high, warranting collaborative efforts to improve screening and adopt better clinical management strategies for DM–TB comorbid patients. Furthermore, being rural residents, family history of DM and HIV/TB co-infection were found to associate with DM among TB patients, highlighting the importance of the above-mentioned risk factors in the clinical management of this comorbidity.
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Affiliation(s)
- Begna Tulu
- Department of Medical Laboratory Sciences, Bahir Dar University, Bahir Dar, Ethiopia. .,Aklilu Lemma Institute of Pathobiology, Addis Ababa University, PO Box 1176, Addis AbabaAddis Ababa, Ethiopia.
| | - Eden Amsalu
- Department of Pediatric Nursing, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yohannes Zenebe
- Department of Medical Laboratory Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Melkamu Abebe
- Department of Pediatric Nursing, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yeshimebet Fetene
- Department of Pediatric Nursing, Bahir Dar University, Bahir Dar, Ethiopia
| | - Manamnot Agegn
- Department of Pediatric Nursing, Bahir Dar University, Bahir Dar, Ethiopia
| | - Alemayehu Abate
- Department of Pediatric Nursing, Bahir Dar University, Bahir Dar, Ethiopia
| | - Keerati Ponpetch
- Sirindhorn College of Public Health Trang, Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute, Ministry of Public Health, Nonthaburi, Thailand
| | - Teshome Bekana
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, PO Box 1176, Addis AbabaAddis Ababa, Ethiopia.,Department of Biomedical Sciences, Faculty of Public Health and Medical Science, Mettu University, Mettu, Ethiopia
| | - Balako Gumi
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, PO Box 1176, Addis AbabaAddis Ababa, Ethiopia
| | - Gobena Ameni
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, PO Box 1176, Addis AbabaAddis Ababa, Ethiopia.,Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, United Arab Emirates University, PO Box 15551, Al Ain, United Arab Emirates
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19
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Madsen Beau De Rochars VE, Keys H, Samuels SK, Jo A, Noland GS, Gonzales M, Blount S, Mainous AG. Prevalence of Diabetes, Prediabetes, and Associated Risk Factors Among Agricultural Village Residents in the Dominican Republic. Am J Trop Med Hyg 2021; 104:2241-2250. [PMID: 33872205 PMCID: PMC8176474 DOI: 10.4269/ajtmh.19-0942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 02/11/2021] [Indexed: 01/03/2023] Open
Abstract
This study examined the prevalence and risk factors of prediabetes and type 2 diabetes among residents of agricultural settlement villages (bateyes) in the Dominican Republic. From March to April 2016, a cross-sectional, multi-stage cluster survey was conducted across the country's three agricultural regions (southwest, east, and north). At selected households, an adult completed a questionnaire to assess demographics, diabetes knowledge, and care, and two household residents of any age provided finger-prick blood samples that were analyzed for hemoglobin A1c (HbA1c). HbA1c was categorized as normal (< 5.7%), prediabetic (5.7-6.4%), or diabetic (≥ 6.5%). The prevalence rates of diabetes and prediabetes were 8.6% (95% confidence interval [CI], 6.2-11.8%) and 20.4% (95% CI, 17.9-23.2%), respectively, among all participants (N = 1293; median age, 35 years; range, 2-96 years), and 10.0% (95% CI, 7.2-13.8%) and 20.0% (95% CI, 17.4-23.0%), respectively, among adults 18 years or older (N = 730). The average age of participants with diabetes was 47.2 years. The average age of participants with prediabetes was 40.7 years. Among adult questionnaire respondents, 64.8% of all participants and 39.4% of patients with diabetes had not been tested for diabetes previously. Among patients with diabetes, 28.4% were previously diagnosed; 1.2% of prediabetes patients were previously diagnosed. Half (50.7%) of the respondents had heard of diabetes. The majority (94.1%) of patients previously diagnosed with diabetes reported using diabetes medication. Among both undiagnosed and previously diagnosed patients with diabetes, diabetes knowledge, previous diabetes testing, and diabetes care-seeking were lowest among Haitian-born participants. A high burden of undiagnosed diabetes and deficiencies in diabetes knowledge, access to care, and diagnosis exist among all batey inhabitants, but most acutely among Haitians. Improvements will require a multi-sectoral approach.
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Affiliation(s)
- Valery E. Madsen Beau De Rochars
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida
| | - Hunter Keys
- Department of Anthropology, University of Amsterdam, Amsterdam, The Netherlands
- The Carter Center, Atlanta, Georgia
| | - Shenae K. Samuels
- Memorial Healthcare System, Office of Human Research, Hollywood, Florida
| | - Ara Jo
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
| | | | - Manuel Gonzales
- Centro Nacional para el Control de Enfermedades Tropicales (CENCET), Santo Domingo, Dominican Republic
| | | | - Arch G. Mainous
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, Florida
- Department of Community Health and Family Medicine, University of Florida, Gainesville, Florida
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20
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Khalid N, Ahmad F, Qureshi FM. Association amid the comorbidity of Diabetes Mellitus in patients of Active Tuberculosis in Pakistan: A matched case control study. Pak J Med Sci 2021; 37:816-820. [PMID: 34104171 PMCID: PMC8155445 DOI: 10.12669/pjms.37.3.3274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objectives: This study aims to test the association between diabetes and tuberculosis. Methods: It is a matched case control study conducted in tertiary care hospitals in 2019-2020. Cases and controls were 144 each, selected on the basis of an odds ratio of 2 at 95% confidence interval with a significance level of 5%. Cases of pulmonary tuberculosis were selected through consecutive sampling technique, either visiting OPD or admitted in hospital. Controls were taken from the general population and frequency matching was done based on age, gender and socioeconomic status. Data was collected through structured questionnaire after taking written consent. Data was analyzed on SPSS version 23. Binary Logistic regression model was applied for finding association between the risk factors and the disease. P value <0.05 was considered statistically significant. Results: Out of all cases and controls, 45% and 20% were diabetics respectively. The association between the risk factors and tuberculosis was estimated by univariate analysis, positive association was found between diabetes and tuberculosis (OR= 3.32), a high frequency of diabetes in cases as compared to controls were observed with a highly significant p- value (<.001). Conclusions: This study provides evidence for a strong positive association between tuberculosis and diabetes.
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Affiliation(s)
- Nadia Khalid
- Dr. Nadia Khalid, MBBS. Senior Lecturer, Department of Community Health Sciences, Bahria University Medical & Dental College, Karachi, Pakistan
| | - Farah Ahmad
- Dr. Farah Ahmad, MCPS-HCSM, MSBE. Associate Director, Health Care System Management, College of Physicians & Surgeons, Karachi, Pakistan
| | - Farhan Muhammad Qureshi
- Dr. Farhan Muhammad Qureshi, MS - Public Health & Health Promotion Assistant Professor, Department of Community Health Sciences, Karachi Institute of Medical Sciences, Malir Cantt, Karachi, Pakistan
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21
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Sembiah S, Nagar V, Gour D, Pal DK, Mitra A, Burman J. Diabetes in tuberculosis patients: An emerging public health concern and the determinants and impact on treatment outcome. J Family Community Med 2020; 27:91-96. [PMID: 32831553 PMCID: PMC7415274 DOI: 10.4103/jfcm.jfcm_296_19] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/24/2020] [Accepted: 04/05/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) and diabetes mellitus are still of much public health concern. Screening of TB patients for diabetes will ensure early case detection, better management of diabetes, and better TB treatment outcome. The objective of this study was to determine the prevalence and associated factors of diabetes in TB patients and their impact on treatment outcome of TB. MATERIALS AND METHODS This was a longitudinal follow-up study of registered TB patients under the Revised National Tuberculosis Control Program in all five TB units of Bhopal district. Participants were contacted and the interview was conducted. The blood sugar of all TB patients was checked, and they were followed up to assess the treatment outcome from October 2014 to September 2017. Data were analyzed using SPSS (version 16.0. Chicago, SPSS Inc.). Logistic regression was done to find the factors for diabetes in TB patients. The Chi-square tests were used to find the difference in treatment outcomes and assess the relative risk for poor outcome in diabetic TB patients. RESULTS Of total 662 TB patients, 82 (12.39%) were diagnosed as diabetic. Age >50 years, males, higher body mass index, pulmonary TB, patients on Category II treatment, and history of smoking were found to be predictors of diabetes in TB patients. The treatment outcome of TB was more unfavorable (defaulter, failure, and death) in diabetic TB patients (16.17%) than in nondiabetic TB patients (5.8%) (risk ratio = 2.78, 1.469-5.284 confidence interval). CONCLUSION The high prevalence of diabetes and the unfavorable treatment outcome in diabetic TB patients make screening and management of diabetes at an early-stage crucial for a better outcome in TB patients.
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Affiliation(s)
- Sembagamuthu Sembiah
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Vivek Nagar
- Department of Community Medicine, L.N. Medical College, Bhopal, Madhya Pradesh, India
| | - Devendra Gour
- Department of Community Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Dinesh K Pal
- Department of Community Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Arun Mitra
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Jayeeta Burman
- Department of Community Medicine, All India Institute of Hygiene and Public Health, Kolkata, West Bengal, India
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22
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Boah M, Adampah T, Jin B, Wang W, Wang K. Trend of tuberculosis case notifications and their determinants in Africa and South-East Asia during 2000-2018: a longitudinal analysis of national data from 58 countries. Infect Dis (Lond) 2020; 52:538-546. [PMID: 32431192 DOI: 10.1080/23744235.2020.1761560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background: The World Health Organization (WHO) regions of Africa and South-East Asia are the epicentres of the global tuberculosis (TB) epidemic. This study aimed at examining the trend and determinants of TB case notifications in the two regions during 2000-2018.Methods: This was a retrospective analysis of yearly, new TB cases notified to the WHO. We obtained data on potential determinants for the 58 countries in the two regions during 2000-2018. Multivariable longitudinal fixed-effects regression analysis was used to quantify the association between the determinants and TB notifications.Results: During 2000-2018, TB notifications and incidence declined in Africa. In South-East Asia, case notifications increased while the incidence declined, on average, by 2% per year during the same period. After controlling for health, socioeconomic indicators, country and year fixed-effects, each 1% increase in the antiretroviral therapy (ART) coverage and the TB treatment success was associated with a decrease per 100,000 population in the TB case notification rate of -1.62 (95% CI: -4.93, -1.90; p = .037) and -0.91(95% CI: -1.54, -0.28; p = .005) respectively. Similarly, each 1-year increase in the life expectancy at birth resulted in a decrease in TB case notification rates of -6.64 (95% CI: -12.32, -0.95; p = .037). By contrast, a 1% increase in the unemployment rate resulted in an increase in TB notification rate of 3.49 cases (95% CI: 0.19, 6.79; p = .039).Conclusion: Improving population health and the broad scale-up of ART coverage could complement existing TB treatment coverage and cure programmes to drive down new cases in Africa and South-East Asia.
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Affiliation(s)
- Michael Boah
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China.,Ghana Health Service, Upper East Region, Bolgatanga, Ghana
| | - Timothy Adampah
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China.,Education, Culture and Health Opportunities (ECHO) Research Group International, Aflao, Ghana
| | - Baiming Jin
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China.,Department of Preventive Medicine, Qiqihar Medical University, Qiqihar, China.,Institute of Cell Biotechnology, China and Russia Medical Research Center, Harbin Medical University, Harbin, China
| | - Wenji Wang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China.,Institute of Cell Biotechnology, China and Russia Medical Research Center, Harbin Medical University, Harbin, China
| | - Kewei Wang
- Center for Endemic Disease Control, Chinese Center for Disease Control and Prevention, Harbin Medical University, Harbin, China.,Institute of Cell Biotechnology, China and Russia Medical Research Center, Harbin Medical University, Harbin, China
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23
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Prevalence of chest symptomatics of tuberculosis among diabetes patients in Udupi taluk. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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24
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Awad SF, Huangfu P, Ayoub HH, Pearson F, Dargham SR, Critchley JA, Abu-Raddad LJ. Forecasting the impact of diabetes mellitus on tuberculosis disease incidence and mortality in India. J Glob Health 2020; 9:020415. [PMID: 31673336 PMCID: PMC6815875 DOI: 10.7189/jogh.09.020415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
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.
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Affiliation(s)
- Susanne F Awad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Population Health Research Institute, St George's, University of London, London, UK
| | - Peijue Huangfu
- Population Health Research Institute, St George's, University of London, London, UK
| | - Houssein H Ayoub
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Department of Mathematics, Statistics, and Physics, Qatar University, Doha, Qatar.,Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Fiona Pearson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Soha R Dargham
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, London, UK.,Joint senior authors
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA.,College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar.,Joint senior authors
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25
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Gezahegn H, Ibrahim M, Mulat E. Diabetes Mellitus and Tuberculosis Comorbidity and Associated Factors Among Bale Zone Health Institutions, Southeast Ethiopia. Diabetes Metab Syndr Obes 2020; 13:3879-3886. [PMID: 33116734 PMCID: PMC7586011 DOI: 10.2147/dmso.s248054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 09/17/2020] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Habtamu Gezahegn
- Madda Walabu University Goba Referral Hospital, School of Medicine, Medical Physiology Unit, Bale Robe, Ethiopia
- Correspondence: Habtamu Gezahegn Email
| | - Mohammed Ibrahim
- Jimma University, Institute of Health, Faculty of Medical Sciences, Department of Biomedical Sciences, Jimma, Ethiopia
| | - Elias Mulat
- Jimma University, Institute of Health, Faculty of Medical Sciences, Department of Biomedical Sciences, Jimma, Ethiopia
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26
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Tenaye L, Mengiste B, Baraki N, Mulu E. Diabetes Mellitus among Adult Tuberculosis Patients Attending Tuberculosis Clinics in Eastern Ethiopia. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7640836. [PMID: 31781641 PMCID: PMC6875401 DOI: 10.1155/2019/7640836] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/17/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND Developing countries are suffering from the previously existing infectious diseases and alarmingly growing burden of noncommunicable diseases like diabetes mellitus. There is increased speculation that diabetes mellitus might attribute to high infectious diseases burden, such as tuberculosis. The global importance of diabetes mellitus as a tuberculosis-risk factor is still not a well-established fact. Thus, we conducted this study to determine the prevalence of diabetes mellitus and its associated factors among adult tuberculosis patients attending tuberculosis clinics. METHODOLOGY We conducted a cross-sectional survey, from March 10 to April 15, 2017, among 421 tuberculosis patients receiving tuberculosis treatment in health facilities of Dire Dawa City Administration Council, Eastern Ethiopia. Study participants were selected using systematic random technique, and data were collected using a structured questionnaire. Fasting blood sugar and anthropometric measurements were carried out for all participants. A logistic regression analysis was performed to identify factors associated with diabetes mellitus. RESULT The prevalence of diabetes mellitus in this study was 13.5%. Age 26-40 (AOR = 6, 95% CI: (1.28, 27.5)), age ≥41(AOR = 9, 95% CI: (1.9, 44.4)), and family history of diabetes (AOR = 3.14, 95% CI: (1.23, 8.02)) were found to have a significant association with diabetes mellitus. CONCLUSION This study found that the magnitude of diabetes mellitus among tuberculosis patients was higher than the national estimated prevalence of diabetes mellitus in Ethiopia. This study suggests the need for screening each tuberculosis patient for diabetes.
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Affiliation(s)
- Lucy Tenaye
- College of Health Sciences and Medicine, Haramaya University, Harar, Ethiopia
| | - Bizatu Mengiste
- College of Health Sciences and Medicine, Haramaya University, Harar, Ethiopia
| | - Negga Baraki
- College of Health Sciences and Medicine, Haramaya University, Harar, Ethiopia
| | - Ermiyas Mulu
- College of Medicine and Health Sciences, Ambo University, Ambo, Ethiopia
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27
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Munseri PJ, Kimambo H, Pallangyo K. Diabetes mellitus among patients attending TB clinics in Dar es Salaam: a descriptive cross-sectional study. BMC Infect Dis 2019; 19:915. [PMID: 31664936 PMCID: PMC6820980 DOI: 10.1186/s12879-019-4539-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 10/09/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND A bi-directional interaction between diabetes mellitus and tuberculosis is well established and has been likened to that between HIV and TB. Whereas HIV screening is standard of care test in sub Saharan Africa TB programs, the same is not true for diabetes mellitus (DM). Sub Saharan Africa, a region with high TB infection rates, is going through an epidemiological transition with rapidly rising prevalence of diabetes. We aimed at characterizing TB patients with DM in order to identify factors associated with TB-DM dual disease among patients attending TB clinics in Dar es Salaam. METHODS A cross-sectional study was conducted between September 2016 and January 2017 among patients attending TB clinics in Dar es Salaam. We collected socio-demographic characteristics, anthropometric measurements and screened for diabetes by measuring fasting blood glucose that was followed by a 2 h postprandial glucose for participants with impaired fasting blood glucose. We examined for socio-demographic and clinical factors associated with diabetes using logistic regression analysis. RESULTS Of the 660 enrolled participants with TB, 25 (3.8%) were on treatment for diabetes while 39 (6.1%) and 147 (23%) of the remaining 635 participants were ultimately diagnosed with DM and impaired fasting blood glucose respectively. The overall prevalence of DM was 9.7% (64/660). Independent risk factors for diabetes included: age > 44 years {OR 4.52, 95% CI: [1.28-15.89]}; family history of diabetes {OR 3.42, 95% [CI 1.88-6.21]}. HIV sero-positive TB patients were less likely to have DM compared to those who were HIV sero-negative {OR 0.35, 95% CI [0.17-0.73]}. CONCLUSIONS Screening for diabetes should be advocated for TB patients aged above 44 years and/or with a family history of diabetes. HIV sero-negative TB patients were more likely to have DM compared to those who were HIV sero-positive. Further studies are needed to confirm this observation and the underlying factors.
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Affiliation(s)
- Patricia J. Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences Dar es Salaam, Box 65315, Dar es Salaam, Tanzania
| | - Henrika Kimambo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences Dar es Salaam, Box 65315, Dar es Salaam, Tanzania
| | - Kisali Pallangyo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences Dar es Salaam, Box 65315, Dar es Salaam, Tanzania
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Kubiak RW, Sarkar S, Horsburgh CR, Roy G, Kratz M, Reshma A, Knudsen S, Salgame P, Ellner JJ, Drain PK, Hochberg NS. Interaction of nutritional status and diabetes on active and latent tuberculosis: a cross-sectional analysis. BMC Infect Dis 2019; 19:627. [PMID: 31311495 PMCID: PMC6636094 DOI: 10.1186/s12879-019-4244-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 06/30/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Malnutrition and diabetes are risk factors for active tuberculosis (TB), possible risk factors for latent TB infection (LTBI), and may interact to alter their effect on these outcomes. Studies to date have not investigated this interaction. METHODS We enrolled 919 newly diagnosed active TB patients and 1113 household contacts at Primary Health Centres in Puducherry and Tamil Nadu, India from 2014 to 2018. In cross-sectional analyses, we used generalized estimating equations to measure additive and multiplicative interaction of body mass index (BMI) and diabetes on two outcomes, active TB and LTBI. RESULTS Among overweight or obese adults, active TB prevalence was 12-times higher in diabetic compared to non-diabetic participants, 2.5-times higher among normal weight adults, and no different among underweight adults (P for interaction < 0.0001). Diabetes was associated with 50 additional active TB cases per 100 overweight or obese participants, 56 per 100 normal weight participants, and 17 per 100 underweight participants (P for interaction < 0.0001). Across BMI categories, screening 2.3-3.8 active TB patients yielded one hyperglycemic patient. LTBI prevalence did not differ by diabetes and BMI*diabetes interaction was not significant. CONCLUSIONS BMI and diabetes are associated with newly diagnosed active TB, but not LTBI. Diabetes conferred the greatest risk of active TB in overweight and obese adults whereas the burden of active TB associated with diabetes was similar for normal and overweight or obese adults. Hyperglycemia was common among all active TB patients. These findings highlight the importance of bi-directional diabetes-active TB screening in India.
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Affiliation(s)
- Rachel W Kubiak
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Box 357236, Seattle, WA, 98195, USA.
| | - Sonali Sarkar
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - C Robert Horsburgh
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, USA
| | - Gautam Roy
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Mario Kratz
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Box 357236, Seattle, WA, 98195, USA.,Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington, Seattle, USA.,Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Ayiraveetil Reshma
- Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Selby Knudsen
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Padmini Salgame
- Center for Emerging Pathogens, Department of Medicine, Rutgers-New Jersey Medical School, Newark, USA
| | - Jerrold J Ellner
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.,Center for Emerging Pathogens, Department of Medicine, Rutgers-New Jersey Medical School, Newark, USA.,Boston Medical Center, Boston, USA
| | - Paul K Drain
- Department of Epidemiology, University of Washington, 1959 NE Pacific Street, Health Sciences Building, Box 357236, Seattle, WA, 98195, USA.,Department of Global Health, University of Washington, Seattle, USA.,Department of Medicine, University of Washington, Seattle, USA
| | - Natasha S Hochberg
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, USA.,Boston Medical Center, Boston, USA
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29
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Magee MJ, Gandhi NR, Kornfeld H. A dual purpose for household contact investigations: preventing TB disease and improving diabetes outcomes. Int J Tuberc Lung Dis 2019; 22:594-595. [PMID: 29862941 DOI: 10.5588/ijtld.18.0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- M J Magee
- Division of Epidemiology and Biostatistics School of Public Health, Georgia State University Atlanta, GA
| | - N R Gandhi
- Department of Epidemiology and Department of Global Health Rollins School of Public Health, Emory University Atlanta, GA, Division of Infectious Diseases, Department of Medicine Emory University School of Medicine Atlanta, GA
| | - H Kornfeld
- Division of Pulmonary, Allergy and Critical Care Department of Medicine, University of Massachusetts Medical School Worcester, MA USA ,
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Alebel A, Wondemagegn AT, Tesema C, Kibret GD, Wagnew F, Petrucka P, Arora A, Ayele AD, Alemayehu M, Eshetie S. Prevalence of diabetes mellitus among tuberculosis patients in Sub-Saharan Africa: a systematic review and meta-analysis of observational studies. BMC Infect Dis 2019; 19:254. [PMID: 30866836 PMCID: PMC6417234 DOI: 10.1186/s12879-019-3892-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 03/07/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Tuberculosis and diabetes mellitus are significant global public health challenges. In Sub-Saharan Africa, study findings regarding prevalence of diabetes mellitus amongst tuberculosis patients have been inconsistent and highly variable. Therefore, this systematic review and meta-analysis estimates the overall prevalence of diabetes mellitus among tuberculosis patients in Sub-Saharan Africa. METHODS Four international databases (PubMed, Google Scholar, Science Direct and Cochrane Library) were systematically searched. We included all observational studies reporting the prevalence of DM among TB patients in Sub-Saharan Africa. All necessary data for this review were extracted using a standardized data extraction format by two authors (CT and AA1). STATA Version 14 statistical software was employed to conduct meta-analysis. The Cochrane Q test statistics and I2 test were used to assess the heterogeneity of the studies. Finally, a random effects meta-analysis model was computed to estimate the pooled prevalence of diabetes mellitus in TB patients. Besides, subgroup analysis was done based on different factors. RESULTS In the meta-analysis, sixteen studies fulfilled the inclusion criteria and were included. The findings of these 16 studies revealed that the pooled prevalence of diabetes mellitus among tuberculosis patients in Sub-Saharan Africa was 9.0% (95% CI: 6.0, 12.0%). The highest prevalence of diabetes mellitus among tuberculosis patients was found in Nigeria (15%), followed by Tanzania (11%), and then Ethiopia (10%). Besides, the prevalence of diabetes mellitus among HIV infected TB patients was (8.9%) which is slightly higher than HIV uninfected (7.7%) TB patients. CONCLUSION Diabetes mellitus among tuberculosis patients in Sub-Saharan Africa was significantly high. Moreover, this study found that there was a high prevalence of DM among HIV infected than uninfected TB patients. It is strongly recommended to screen for DM among TB patients and special emphasis should be given for early screening of DM among TB/HIV co-infected patients.
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Affiliation(s)
- Animut Alebel
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | | | - Cheru Tesema
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Getiye Dejenu Kibret
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Fasil Wagnew
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Pammla Petrucka
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
- School of Life Sciences and Bioengineering, Nelson Mandela African Institute of Science and Technology, Arusha, Tanzania
| | - Amit Arora
- School of Science and Health, Western Sydney University, Penrith, NSW 2751 Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW 2751 Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW 2145 Australia
- Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW 2010 Australia
| | - Amare Demsie Ayele
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulunesh Alemayehu
- College of Health Sciences, Debre Markos University, P.O. Box 269, Debre Markos, Ethiopia
| | - Setegn Eshetie
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Basir MS, Habib SS, Zaidi SM, Khowaja S, Hussain H, Ferrand RA, Khan AJ. Operationalization of bi-directional screening for tuberculosis and diabetes in private sector healthcare clinics in Karachi, Pakistan. BMC Health Serv Res 2019; 19:147. [PMID: 30841929 PMCID: PMC6404337 DOI: 10.1186/s12913-019-3975-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/26/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Many countries are facing overlapping epidemics of tuberculosis (TB) and diabetes mellitus (DM). Diabetes increases the overall risk of developing Tuberculosis (TB) and contributes to adverse treatment outcomes. Active screening for both diseases can reduce TB transmission and prevent the development of complications of DM. We investigated bi-directional TB-DM screening in Karachi, Pakistan, a country that ranks fifth among high TB burden countries, and has the seventh highest country burden for DM. METHODS Between February to November 2014, community-based screeners identified presumptive TB and DM through verbal screening at private health clinics. Individuals with presumptive TB were referred for a chest X-ray and Xpert MTB/RIF. Presumptive DM cases had random blood glucose (RBS) tested. All individuals with bacteriologically positive TB were referred for diabetes testing (RBS). All pre-diabetics and diabetics were referred for a chest X-ray and Xpert MTB/RIF test. The primary outcomes of this study were uptake of TB and DM testing. RESULTS A total of 450,385 individuals were screened, of whom 18,109 had presumptive DM and 90,137 had presumptive TB. 14,550 of these individuals were presumptive for both DM and TB. The uptake of DM testing among those with presumptive diabetes was 26.1% while the uptake of TB testing among presumptive TB cases was 5.9%. Despite efforts to promote bi-directional screening of TB and DM, the uptake of TB testing among pre-diabetes and diabetes cases was only 4.7%, while the uptake of DM testing among MTB positive cases was 21.8%. CONCLUSION While a high yield for TB was identified among pre-diabetics and diabetics along with a high yield of DM among individuals diagnosed with TB, there was a low uptake of TB testing amongst presumptive TB patients who were recorded as pre-diabetic or diabetic. Bi-directional screening for TB and DM which includes the integration of TB diagnostics, DM screening and TB-DM treatment within existing health care programs will need to address the operational challenges identified before implementing this as a strategy in public health programs.
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Affiliation(s)
- Mashal S. Basir
- Interactive Research & Development, 4th Floor, Woodcraft Building, Plot No. 3 & 3-A, Sector 47, Korangi Creek Road, Karachi, Pakistan
| | - Shifa S. Habib
- Community Health Solutions, 9th Floor, Al-Tijarah Building, Main Shahrah-e-Faisal, Karachi, Pakistan
| | - Syed M.A. Zaidi
- Community Health Solutions, 9th Floor, Al-Tijarah Building, Main Shahrah-e-Faisal, Karachi, Pakistan
| | - Saira Khowaja
- Interactive Research & Development, 4th Floor, Woodcraft Building, Plot No. 3 & 3-A, Sector 47, Korangi Creek Road, Karachi, Pakistan
| | - Hamidah Hussain
- Interactive Research & Development, 4th Floor, Woodcraft Building, Plot No. 3 & 3-A, Sector 47, Korangi Creek Road, Karachi, Pakistan
| | - Rashida A. Ferrand
- Interactive Research & Development, London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Aamir J. Khan
- Interactive Research & Development, 4th Floor, Woodcraft Building, Plot No. 3 & 3-A, Sector 47, Korangi Creek Road, Karachi, Pakistan
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Nascimento CV, Soares SM. [Co-management of tuberculosis and diabetes: an integrative reviewManejo integrado de la tuberculosis y la diabetes: revisión integrativa]. Rev Panam Salud Publica 2019; 43:e21. [PMID: 31093245 PMCID: PMC6459364 DOI: 10.26633/rpsp.2019.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/25/2018] [Indexed: 11/24/2022] Open
Abstract
Objetivo. Identificar as evidências sobre manejo integrado de tuberculose e diabetes disponíveis na literatura para o contexto latino-americano. Métodos. Foi realizada uma revisão integrativa da literatura com busca nas bases de dados LILACS, Web of Science e PubMed. A estratégia utilizou como termos de busca “tuberculose”, “diabetes mellitus” e “manejo integrado”. Foram incluídos artigos científicos sobre estudos realizados na América Latina, publicados de 2011 a 2017, com acesso livre ao texto integral e publicação em inglês, espanhol ou português. Foram coletados dados relativo aos autores, delineamento, amostra, principais resultados, país e ano da publicação. Finalmente, os estudos foram classificados em níveis de evidência. Resultados. Foram incluídos 20 estudos, dos quais 60% apresentaram baixa evidência científica (nível IV). Conforme esses estudos, os pacientes com diabetes possuem maior risco de desenvolver tuberculose, especialmente aqueles com controle glicêmico ineficaz. Além disso, pacientes com tuberculose-diabetes apresentam atraso na conversão do escarro e maior probabilidade de falha terapêutica e morte. Há maior prevalência da associação tuberculose-diabetes no sexo masculino. Em relação aos registros de tuberculose e diabetes em prontuários ou fichas eletrônicas de informação nos serviços de saúde, há falhas ou ausência de anotações. Foi identificado alto custo financeiro do manejo clínico em indivíduos com a comorbidade. A equipe multidisciplinar possui papel imprescindível na prevenção e promoção em saúde, nos três níveis de atenção. Conclusão. O rastreamento bidirecional de tuberculose-diabetes poderá implicar em melhor controle desses agravos, principalmente em países em desenvolvimento e em áreas endêmicas para tuberculose.
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Affiliation(s)
- Cíntia Vieira Nascimento
- Hospital Júlia Kubitschek Hospital Júlia Kubitschek Fundação Hospitalar do Estado de Minas Gerais (FHEMIG) Belo HorizonteMG Brasil Fundação Hospitalar do Estado de Minas Gerais (FHEMIG), Hospital Júlia Kubitschek, Belo Horizonte (MG), Brasil
| | - Sônia Maria Soares
- Escola de Enfermagem Escola de Enfermagem Universidade Federal de Minas Gerais Belo HorizonteMG Brasil Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte (MG), Brasil
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Balakrishnan S, Rakesh PS, Viswanathan K, Nelson V, Simon S, Nair SA, Mathew ME, Sunilkumar M. Higher risk of developing active TB among adult diabetics exposed to TB during childhood: A study from Kerala, India. J Family Med Prim Care 2019; 8:695-700. [PMID: 30984697 PMCID: PMC6436278 DOI: 10.4103/jfmpc.jfmpc_344_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Factors associated with tuberculosis (TB) in Kerala, the southern Indian state that notifies approximately 33 microbiologically confirmed new cases per 100,000 population every year for the past two decades, are still unclear. We did a community-based case-control study in Kollam district, Kerala, to identify the individual-level risk factors for TB. METHODS Structured questionnaire was applied to 101 microbiologically confirmed new TB cases registered under Revised National Tuberculosis Control Program and 202 age- and gender-matched neighborhood controls without present or past TB. Information was sought on socioeconomic status (SES), smoking, consumption of alcohol, close contact with active TB during childhood or recent past, diabetes mellitus (DM), and other comorbid conditions. RESULTS Close contact with TB during childhood [odds ratio (OR) 15.88, 95% confidence interval (CI) 3.21-78.55], recent close contact with TB (OR 4.81, 95% CI 2.09-11.07), DM (OR 1.64, 95% CI 1.04-3.06), SES (OR 2.16, 95% CI 1.16-4.03), smoking more than 10 cigarettes/beedis per day (OR 3.32, 95% CI 1.27-8.96), consuming more than 10 standard drinks per week (OR 2.91, 95% CI 1.33-6.37), and the interaction term of having close contact with TB during childhood and DM at present (OR 7.37, 95% CI 1.18-50.29) were found to be associated with TB. CONCLUSION Close contact with a case of TB, presence of DM, lower SES, smoking, and alcohol consumption were associated with active TB in Kollam. Having close contact with a case of TB during childhood and development of DM in later life together are significantly associated with active TB in the study population. The findings also direct further studies to confirm and explore mechanisms of interaction of diabetes with childhood exposure to TB.
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Affiliation(s)
| | - P. S. Rakesh
- Amrita Institute of Medical Sciences, Amrita University, Kochi, India
| | | | - Vincy Nelson
- Community Medicine, Travancore Medical College, Kollam, India
| | - Sony Simon
- Biostatistics, Travancore Medical College, Kollam, India
| | - Sreenivas A. Nair
- World Health Organisation, RNTCP Technical Assistance Project, India
| | - Manu E. Mathew
- World Health Organisation, RNTCP Technical Assistance Project, India
| | - M. Sunilkumar
- State TB Training and Demonstration Centre, Thiruvananthapuram, Kerala, India
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Mave V, Meshram S, Lokhande R, Kadam D, Dharmshale S, Bharadwaj R, Kagal A, Pradhan N, Deshmukh S, Atre S, Sahasrabudhe T, Barthwal M, Meshram S, Kakrani A, Kulkarni V, Raskar S, Suryavanshi N, Shivakoti R, Chon S, Selvin E, Gupte A, Gupta A, Gupte N, Golub JE. Prevalence of dysglycemia and clinical presentation of pulmonary tuberculosis in Western India. Int J Tuberc Lung Dis 2019; 21:1280-1287. [PMID: 29297449 DOI: 10.5588/ijtld.17.0474] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
SETTING Pune, India. OBJECTIVES To estimate the prevalence and risk factors of pre-diabetes mellitus (DM) and DM, and its associations with the clinical presentation of tuberculosis (TB). DESIGN Screening for DM was conducted among adults (age 18 years) with confirmed TB between December 2013 and January 2017. We used multinomial regression to evaluate the risk factors for pre-DM (glycated hemoglobin [HbA1c] 5.7-6.5% or fasting glucose 100-125 mg/dl) and DM (HbA1c 6.5% or fasting glucose 126 mg/dl or random blood glucose > 200 mg/dl or self-reported DM history/treatment) and the association of dysglycemia with the severity of TB disease. RESULTS Among 1793 participants screened, 890 (50%) had microbiologically confirmed TB. Of these, 33% had pre-DM and 18% had DM; 41% were newly diagnosed. The median HbA1c level among newly diagnosed DM was 7.0% vs. 10.3% among known DM (P < 0.001). DM (adjusted OR [aOR] 4.94, 95%CI 2.33-10.48) and each per cent increase in HbA1c (aOR 1.42, 95%CI 1.01-2.01) was associated with >1+ smear grade or 9 days to TB detection. CONCLUSION Over half of newly diagnosed TB patients had DM or pre-DM. DM and increasing dysglycemia was associated with higher bacterial burden at TB diagnosis, potentially indicating a higher risk of TB transmission to close contacts.
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Affiliation(s)
- V Mave
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Meshram
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - R Lokhande
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - D Kadam
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - S Dharmshale
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - R Bharadwaj
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - A Kagal
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Byramjee-Jeejeebhoy Government Medical College, Pune, India
| | - N Pradhan
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - S Deshmukh
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - S Atre
- Dr D Y Patil Medical College, Pune, India
| | | | - M Barthwal
- Dr D Y Patil Medical College, Pune, India
| | - S Meshram
- Dr D Y Patil Medical College, Pune, India
| | - A Kakrani
- Dr D Y Patil Medical College, Pune, India
| | - V Kulkarni
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - S Raskar
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - N Suryavanshi
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - R Shivakoti
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S Chon
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - E Selvin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A Gupte
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - A Gupta
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - N Gupte
- Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - J E Golub
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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35
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McMurry HS, Mendenhall E, Rajendrakumar A, Nambiar L, Satyanarayana S, Shivashankar R. Coprevalence of type 2 diabetes mellitus and tuberculosis in low-income and middle-income countries: A systematic review. Diabetes Metab Res Rev 2019; 35:e3066. [PMID: 30144270 DOI: 10.1002/dmrr.3066] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 08/12/2018] [Accepted: 08/18/2018] [Indexed: 11/09/2022]
Abstract
Increasing coprevalence of diabetes mellitus (DM) and tuberculosis (TB) in low-income and middle-income countries (LMICs) indicates a rising threat to the decades of progress made against TB and requires global attention. This systematic review provides a summary of type 2 diabetes and tuberculosis coprevalence in various LMICs. We searched PubMed, Ovid Medline, Embase, and PsychINFO databases for studies that provided estimates of TB-DM coprevalence in LMICs published between 1990 and 2016. Studies that were non-English and exclusively conducted in multidrug resistant-tuberculosis or type 1 diabetes and inpatient settings were excluded. We reviewed 84 studies from 31 countries. There were huge diversity of study designs and diagnostic methods used to estimate coprevalence, and this precluded pooling of the results. Most studies (n = 78) were from small, localized settings. The DM prevalence among TB patients in various LMICs varied from 1.8% to 45%, with the majority (n = 44) between 10% and 30%. The TB prevalence among people with DM ranged from 0.1% to 6.0% with most studies (n = 9) reporting prevalences less than 2%. Coprevalence of TB-DM was higher than general population prevalence of either diseases in these countries. This study underscores the need for intervention and more focused research on TB DM bidirectional screening programs in low-income and middle-income countries as well as integrated chronic disease management.
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Affiliation(s)
- Hannah Stowe McMurry
- University of Miami Miller School of Medicine, Miami, FL, USA
- Centre for Chronic Disease Control, Delhi, India
| | - Emily Mendenhall
- Science, Technology, and International Affairs Program, School of Foreign Service, Georgetown University, Washington, DC, USA
| | | | - Lavanya Nambiar
- Public Health Foundation of India, Delhi, India
- Department of Health Policy, Management Columbia University Mailman School of Public Health, New York, NY, USA
| | | | - Roopa Shivashankar
- Centre for Chronic Disease Control, Delhi, India
- Public Health Foundation of India, Delhi, India
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36
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Misra A, Sattar N, Tandon N, Shrivastava U, Vikram NK, Khunti K, Hills AP. Clinical management of type 2 diabetes in south Asia. Lancet Diabetes Endocrinol 2018; 6:979-991. [PMID: 30287103 DOI: 10.1016/s2213-8587(18)30199-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 02/07/2023]
Abstract
Compared with other ethnic groups, south Asian people with type 2 diabetes tend to develop the disease at a younger age and manifest with higher glycaemia, dyslipidaemia, nephropathy, and cardiovascular diseases. Additionally, specific issues that can affect treatment of type 2 diabetes in south Asia include poor awareness of the disease, delay in diagnosis, inadequate treatment, the use of ineffective and often harmful alternative medicines, and frequent non-compliance with lifestyle recommendations and drug treatment. Disease development at younger ages, delayed diagnosis, and inadequate management result in early development of severe complications and premature mortality. In this Series paper, we describe the challenges associated with the increasing burden of type 2 diabetes in south Asia and discuss ways to improve clinical care of people with the disorder in the region (defined to include Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka). Treatment of diabetes in south Asia needs to be individualised on the basis of diverse and heterogeneous lifestyle, phenotype, environmental, social, cultural, and economic factors. Aggressive management of risk factors from diagnosis is necessary to reduce the risk of microvascular and macrovascular complications, focusing on provision of basic treatments (eg, metformin, low-cost statins, and blood pressure-lowering drugs) and other interventions such as smoking cessation. Strengthening of the primary care model of care, better referral linkages, and implementation of rehabilitation services to care for patients with chronic complications will be important. Finally, improvement of physicians' skills, provision of relevant training to non-physician health-care workers, and the development and regular updating of national clinical management guidelines will also be crucial to improve diabetes care in the region.
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Affiliation(s)
- Anoop Misra
- Fortis C-DOC Centre of Excellence for Diabetes, Metabolic Diseases, and Endocrinology, New Delhi, India; National Diabetes, Obesity, and Cholesterol Foundation, New Delhi, India; Diabetes Foundation (India), New Delhi, India.
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Usha Shrivastava
- National Diabetes, Obesity, and Cholesterol Foundation, New Delhi, India
| | - Naval K Vikram
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Leicester, UK
| | - Andrew P Hills
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS, Australia
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37
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Gadallah M, Amin W, Fawzy M, Mokhtar A, Mohsen A. Screening for diabetes among tuberculosis patients: a nationwide population-based study in Egypt. Afr Health Sci 2018; 18:884-890. [PMID: 30766551 PMCID: PMC6354872 DOI: 10.4314/ahs.v18i4.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The prevalence of type 2 diabetes mellitus (DM) is increasing rapidly in Egypt and considered one of the major health problems in the Eastern Mediterranean region. Objectives To measure the prevalence of diabetes and detect the undiagnosed cases of diabetes mellitus among patient with tuberculosis. Methods Study Design: Nationwide population-based study. To diagnose DM among TB patients, we used a fasting blood sugar level of ≥ 126 mg/dl and a post-prandial blood glucose test result of ≥ 200 mg/dl. Results Screening for DM among 1435 TB patients' with no history of DM detected 30 new cases of DM, with a case detection rate of 2.09%. The highest screening yields were among TB patients aged ≥ 40 years, females and those with pulmonary TB. The number needed to screen (NNS) TB patients for detecting one new case of DM was 48 while the lowest values were for older age (NNS=27) and females (NNS=29). Conclusion Older age and being females and those with pulmonary type of TB were more prone to the double burden of TB and DM. Identifying cases with double burden of diseases will improve the proper management of both diseases and prevent complications.
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Affiliation(s)
- Mohsen Gadallah
- Community, Environmental and Occupational Medicine. Faculty of Medicine - Ain Shams University, Cairo 11566 Egypt
| | - Wagdy Amin
- Ministry of Health and Population - Chest Directorate, National Tuberculosis Control Program, Cairo, Egypt
| | - Magdy Fawzy
- Ministry of Health and Population - Chest Directorate, National Tuberculosis Control Program, Cairo, Egypt
| | - Alaa Mokhtar
- Ministry of Health and Population - Chest Directorate, National Tuberculosis Control Program, Cairo, Egypt
| | - Amira Mohsen
- National Research Center, Cairo, Egypt, Department of Community Medicine, Cairo, Egypt
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38
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Hoa NB, Phuc PD, Hien NT, Hoa VQ, Thuong PH, Anh PT, Nhung NV. Prevalence and associated factors of diabetes mellitus among tuberculosis patients in Hanoi, Vietnam. BMC Infect Dis 2018; 18:603. [PMID: 30497410 PMCID: PMC6267094 DOI: 10.1186/s12879-018-3519-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 11/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is recognized as an important comorbidity for the development of tuberculosis (TB). With the increase of DM burden globally, concerns have been raised about the emerging co-epidemics of DM and TB, especially in low- and middle-income countries. METHODS A facility-based, cross-sectional study was carried out in all 30 district TB units in Hanoi, Vietnam. All eligible, diagnosed TB patients aged 15 years old or older were asked to provide consent and were screened for diabetes using fasting blood glucose (FBG). Pre-tested semi-structured questionnaires were used for collecting demographic data, lifestyle habits and clinical data. Identification of pre-diabetes or diabetes in TB patients was done in accordance to parameters set by the American Diabetes Association (2016). RESULTS Of 870 eligible TB patients, 831 (95.5%) participated in the study. Of those, 241 (29%; 95%CI: 25.9-32.1%) were prediabetic and 114 (13.7%; 95%CI: 11.4-16.1%) were found to have DM. The risk of DM was higher in patients belonging to the age group 40-64 years (OR 6.09; 95%CI 2.81-13.2); or the age group 65 years or older (OR 2.65; 95%CI 1.65-4.25) or who have a family history of DM (OR 2.71; 95%CI 1.33-5.50). CONCLUSIONS This study demonstrated high prevalence of DM and prediabetes among TB patients in Hanoi, Vietnam. National Tuberculosis Programme needs to establish a systematic screening process for DM among TB patients.
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Affiliation(s)
- N B Hoa
- Vietnam National Lung Hospital, National Tuberculosis Programme Vietnam, 463 Hoang Hoa Tham street, Badinh District, Hanoi, Vietnam. .,Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.
| | - P D Phuc
- Center for Public Health and Ecosystem Research, Hanoi University of Public Health, Hanoi, Vietnam.,Institute of Environmental Health and Sustainable Development, Hanoi, Vietnam
| | - N T Hien
- Center for Public Health and Ecosystem Research, Hanoi University of Public Health, Hanoi, Vietnam.,Institute of Environmental Health and Sustainable Development, Hanoi, Vietnam
| | - V Q Hoa
- Vietnam National Lung Hospital, National Tuberculosis Programme Vietnam, 463 Hoang Hoa Tham street, Badinh District, Hanoi, Vietnam
| | | | - P T Anh
- Hanoi Lung Hospital, Hanoi, Vietnam
| | - N V Nhung
- Vietnam National Lung Hospital, National Tuberculosis Programme Vietnam, 463 Hoang Hoa Tham street, Badinh District, Hanoi, Vietnam.,Vietnam Association for Tuberculosis and Lung Disease, Hanoi, Vietnam
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39
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Siddiqui AN, Hussain S, Siddiqui N, Khayyam KU, Tabrez S, Sharma M. Detrimental association between diabetes and tuberculosis: An unresolved double trouble. Diabetes Metab Syndr 2018; 12:1101-1107. [PMID: 29802074 DOI: 10.1016/j.dsx.2018.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/14/2018] [Indexed: 12/31/2022]
Abstract
Despite significant efforts made to control tuberculosis (TB) through DOTS program, the increasing burden of diabetes mellitus (DM) threatens the progress in reducing TB-related mortality, particularly in developing countries. In recent years, TB-DM comorbidity continues to remain high in countries where DM is on rampant. DM increases the risk of TB, reactivates the dormant TB and worsens the TB treatment outcome. The present review highlights the current findings regarding the prevalence and association of TB-DM comorbidity along with their public health implications. This review will increase the awareness among researchers, policymakers and clinicians, regarding the current scenario of TB-DM association.
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Affiliation(s)
- Ali Nasir Siddiqui
- Department of Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Hamdard University, New Delhi, 110062, India
| | - Salman Hussain
- Department of Pharmaceutical Medicine, School of Pharmaceutical Education and Research, Hamdard University, New Delhi, 110062, India
| | - Nahida Siddiqui
- Department of Pharmacognosy & Phytochemistry, School of Pharmaceutical Education and Research, Hamdard University, New Delhi, 110062, India
| | - Khalid Umer Khayyam
- Department of Epidemiology & Public Health, National Institute of Tuberculosis & Respiratory Diseases, New Delhi, 110030, India
| | - Shams Tabrez
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Manju Sharma
- Department of Pharmacology, School of Pharmaceutical Education and Research, Hamdard University, New Delhi, 110062, India.
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40
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Lu CL, Perera R, Farrah H, Waring J. Diabetes screening among active tuberculosis patients in Western Australia Tuberculosis Control Program using HbA1c. Intern Med J 2018; 49:630-633. [PMID: 30329203 DOI: 10.1111/imj.14143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/04/2018] [Accepted: 10/06/2018] [Indexed: 01/06/2023]
Abstract
BACKGROUND Diabetes mellitus is an important risk factor for tuberculosis (TB), and studies in high TB burden countries have shown diabetes screening to be both feasible and to have a high yield. However, scarce information is available for low TB burden countries. Diabetes screening was previously not part of our routine practice. AIM To screen and determine the prevalence of diabetes in the Western Australian Tuberculosis Control Program. METHODS We measured HbA1c and random plasma glucose in patients with active TB. We also collected details on their demographics, TB and diabetes. RESULTS A total of 105 patients was recruited over a year. Of those, 17 (16.2%) had diabetes. Seven cases (6.7%) were newly diagnosed diabetics. Age, cavitating disease and family history of diabetes were found to be significantly associated with diabetes. Multilobar disease, gender, body mass index, smear and culture positivity were not significantly different between groups. CONCLUSION Our study showed high prevalence of diabetes among active TB patients. Diabetes screening at diagnosis of active TB presents as a good opportunity to detect diabetes even in low prevalence country and has become part of our standard care.
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Affiliation(s)
- Cheng L Lu
- Department of Respiratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Ruad Perera
- Department of Respiratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,The Anita Clayton Centre, Western Australia Tuberculosis Control Program, Perth, Western Australia, Australia
| | - Hussein Farrah
- The Anita Clayton Centre, Western Australia Tuberculosis Control Program, Perth, Western Australia, Australia
| | - Justin Waring
- Department of Respiratory Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,The Anita Clayton Centre, Western Australia Tuberculosis Control Program, Perth, Western Australia, Australia
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Sagili KD, Satyanarayana S, Chadha SS, Wilson NC, Kumar AMV, Moonan PK, Oeltmann JE, Chadha VK, Nagaraja SB, Ghosh S, Q Lo T, Volkmann T, Willis M, Shringarpure K, Reddy RC, Kumar P, Nair SA, Rao R, Yassin M, Mwangala P, Zachariah R, Tonsing J, Harries AD, Khaparde S. Operational research within a Global Fund supported tuberculosis project in India: why, how and its contribution towards change in policy and practice. Glob Health Action 2018; 11:1445467. [PMID: 29553308 PMCID: PMC5912428 DOI: 10.1080/16549716.2018.1445467] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The Global Fund encourages operational research (OR) in all its grants; however very few reports describe this aspect. In India, Project Axshya was supported by a Global Fund grant to improve the reach and visibility of the government Tuberculosis (TB) services among marginalised and vulnerable communities. OR was incorporated to build research capacity of professionals working with the national TB programme and to generate evidence to inform policies and practices. OBJECTIVES To describe how Project Axshya facilitated building OR capacity within the country, helped in addressing several TB control priority research questions, documented project activities and their outcomes, and influenced policy and practice. METHODS From September 2010 to September 2016, three key OR-related activities were implemented. First, practical output-oriented modular training courses were conducted (n = 3) to build research capacity of personnel involved in the TB programme, co-facilitated by The Union, in collaboration with the national TB programme, WHO country office and CDC, Atlanta. Second, two large-scale Knowledge, Attitude and Practice (KAP) surveys were conducted at baseline and mid-project to assess the changes pertaining to TB knowledge, attitudes and practices among the general population, TB patients and health care providers over the project period. Third, studies were conducted to describe the project's core activities and outcomes. RESULTS In the training courses, 44 participant teams were supported to develop research protocols on topics of national priority, resulting in 28 peer-reviewed scientific publications. The KAP surveys and description of project activities resulted in 14 peer-reviewed publications. Of the published papers at least 12 have influenced change in policy or practice. CONCLUSIONS OR within a Global Fund supported TB project has resulted in building OR capacity, facilitating research in areas of national priority and influencing policy and practice. We believe this experience will provide guidance for undertaking OR in Global Fund projects.
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Affiliation(s)
- Karuna D Sagili
- a Department of Tuberculosis and Communicable Diseases , International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office , New Delhi , India
| | - Srinath Satyanarayana
- b Centre for Operational Research , International Union Against Tuberculosis and Lung Disease , Paris , France
| | - Sarabjit S Chadha
- a Department of Tuberculosis and Communicable Diseases , International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office , New Delhi , India
| | - Nevin C Wilson
- c Independent Senior Public Health Consultant , Nilgiris , Tamil Nadu , India
| | - Ajay M V Kumar
- b Centre for Operational Research , International Union Against Tuberculosis and Lung Disease , Paris , France
| | - Patrick K Moonan
- d Division of Global HIV and Tuberculosis , US Centers for Disease Control , Atlanta , GA , USA
| | - John E Oeltmann
- d Division of Global HIV and Tuberculosis , US Centers for Disease Control , Atlanta , GA , USA
| | - Vineet K Chadha
- e Epidemiology and Research Division , National Tuberculosis Institute , Bangalore , India
| | | | - Smita Ghosh
- d Division of Global HIV and Tuberculosis , US Centers for Disease Control , Atlanta , GA , USA
| | - Terrence Q Lo
- d Division of Global HIV and Tuberculosis , US Centers for Disease Control , Atlanta , GA , USA
| | - Tyson Volkmann
- d Division of Global HIV and Tuberculosis , US Centers for Disease Control , Atlanta , GA , USA
| | - Matthew Willis
- d Division of Global HIV and Tuberculosis , US Centers for Disease Control , Atlanta , GA , USA
| | - Kalpita Shringarpure
- g Department of Community Medicine , Government Medical College and SSG Hospital , Vadodara , India
| | | | - Prahlad Kumar
- h National Tuberculosis Institute , Bangalore , India
| | - Sreenivas A Nair
- i World Health Organisation India Country Office , New Delhi , India
| | - Raghuram Rao
- j Central Tuberculosis Division , Ministry of Health and Family Welfare, Government of India
| | - Mohammed Yassin
- k The Global Fund to fight AIDS , Tuberculosis and Malaria , Geneva , Switzerland
| | - Perry Mwangala
- k The Global Fund to fight AIDS , Tuberculosis and Malaria , Geneva , Switzerland
| | - Rony Zachariah
- l Médecins sans Frontières , Brussels Operational Center (LuxoR) , Luxembourg City , Luxembourg
| | - Jamhoih Tonsing
- m International Union Against Tuberculosis and Lung Disease , South-East Asia Regional Office , New Delhi , India
| | - Anthony D Harries
- b Centre for Operational Research , International Union Against Tuberculosis and Lung Disease , Paris , France
| | - Sunil Khaparde
- j Central Tuberculosis Division , Ministry of Health and Family Welfare, Government of India
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Grint D, Alisjhabana B, Ugarte-Gil C, Riza AL, Walzl G, Pearson F, Ruslami R, Moore DAJ, Ioana M, McAllister S, Ronacher K, Koeseomadinata RC, Kerry-Barnard SR, Coronel J, Malherbe ST, Dockrell HM, Hill PC, Van Crevel R, Critchley JA. Accuracy of diabetes screening methods used for people with tuberculosis, Indonesia, Peru, Romania, South Africa. Bull World Health Organ 2018; 96:738-749. [PMID: 30455529 PMCID: PMC6239004 DOI: 10.2471/blt.17.206227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 11/27/2022] Open
Abstract
Objective To evaluate the performance of diagnostic tools for diabetes mellitus, including laboratory methods and clinical risk scores, in newly-diagnosed pulmonary tuberculosis patients from four middle-income countries. Methods In a multicentre, prospective study, we recruited 2185 patients with pulmonary tuberculosis from sites in Indonesia, Peru, Romania and South Africa from January 2014 to September 2016. Using laboratory-measured glycated haemoglobin (HbA1c) as the gold standard, we measured the diagnostic accuracy of random plasma glucose, point-of-care HbA1c, fasting blood glucose, urine dipstick, published and newly derived diabetes mellitus risk scores and anthropometric measurements. We also analysed combinations of tests, including a two-step test using point-of-care HbA1cwhen initial random plasma glucose was ≥ 6.1 mmol/L. Findings The overall crude prevalence of diabetes mellitus among newly diagnosed tuberculosis patients was 283/2185 (13.0%; 95% confidence interval, CI: 11.6–14.4). The marker with the best diagnostic accuracy was point-of-care HbA1c (area under receiver operating characteristic curve: 0.81; 95% CI: 0.75–0.86). A risk score derived using age, point-of-care HbA1c and random plasma glucose had the best overall diagnostic accuracy (area under curve: 0.85; 95% CI: 0.81–0.90). There was substantial heterogeneity between sites for all markers, but the two-step combination test performed well in Indonesia and Peru. Conclusion Random plasma glucose followed by point-of-care HbA1c testing can accurately diagnose diabetes in tuberculosis patients, particularly those with substantial hyperglycaemia, while reducing the need for more expensive point-of-care HbA1c testing. Risk scores with or without biochemical data may be useful but require validation.
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Affiliation(s)
- Daniel Grint
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, England
| | - Bachti Alisjhabana
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Cesar Ugarte-Gil
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Anca-Leila Riza
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Gerhard Walzl
- Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
| | - Fiona Pearson
- Population Health Research Institute, St George's University of London, Cranmer Terrace, London SW17 0RE, England
| | - Rovina Ruslami
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - David A J Moore
- Laboratorio de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Mihai Ioana
- Human Genomics Laboratory, Universitatea de Medicina si Farmacie din Craiova, Craiova, Romania
| | - Susan McAllister
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Katharina Ronacher
- Mater Medical Research, Translational Research Institute, University of Queensland, Brisbane, Australia
| | - Raspati C Koeseomadinata
- Infectious Disease Research Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Sarah R Kerry-Barnard
- Population Health Research Institute, St George's University of London, Cranmer Terrace, London SW17 0RE, England
| | - Jorge Coronel
- Laboratorio de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, San Martin de Porres, Peru
| | - Stephanus T Malherbe
- Division of Molecular Biology and Human Genetics, Stellenbosch University, Cape Town, South Africa
| | - Hazel M Dockrell
- Department of Immunology and Infection, London School of Hygiene & Tropical Medicine, London, England
| | - Philip C Hill
- Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Reinout Van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Julia A Critchley
- Population Health Research Institute, St George's University of London, Cranmer Terrace, London SW17 0RE, England
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Mendoza-Almanza G, Rivas-Santiago CE, Salgado Bustamante M, López-Hernández Y. Diabetes and tuberculosis in Mexico: results from epidemiological studies. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-017-0599-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Mburu JW, Kingwara L, Ester M, Andrew N. Use of classification and regression tree (CART), to identify hemoglobin A1C (HbA 1C) cut-off thresholds predictive of poor tuberculosis treatment outcomes and associated risk factors. J Clin Tuberc Other Mycobact Dis 2018; 11:10-16. [PMID: 31720385 PMCID: PMC6830151 DOI: 10.1016/j.jctube.2018.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 01/18/2018] [Accepted: 01/23/2018] [Indexed: 11/23/2022] Open
Abstract
Background Rifampin-based therapy potentially exacerbates glycemic control among TB patients who are already at high risk of hyperglycemia. This impacts negatively to the optimal care of TB- diabetes mellitus co-affected patients. Classification and regression tree (CART), a machine-learning algorithm impervious to statistical assumptions is one of the ideal tools for clinical decision-making that can be used to identify hemoglobin A1C (HbA1C) cut-off thresholds predictive of poor TB treatment outcomes in such populations. Methods 340TB smear positive patients attending two peri-urban clinics were recruited and prospectively followed up for six months. Baseline HbA1C and random blood glucose (RBG) levels were determined. CART was then used to identify cut-off thresholds and rank outcome predictors at end of therapy by determining Risk ratios (RR) and 95% confidence interval (CI) of each predictor threshold. Fractal geometry law explained effect of weight, while U-shaped curve explained effect of HbA1C on these clinical outcomes. Results Of the 340 patients enrolled: 84%were cured, 7% completed therapy and 9% had unfavorable outcomes out of which 4% (n = 32) had microbiologic failure. Using CART HbA1C identified thresholds were >2.95%, 2.95–4.55% and >4.55%, containing 8/11 (73%), 111/114 (97%) and 189/215 (88%) of patients who experienced favorable outcomes. RR for favorable outcome in patients with weight <53.25 Kg compared to >53.25 Kg was 0.61 (95% CI, 0.45–0.88) among patients with HbA1C >4.55%. Simulation of the CART model with 13 patients data failed therapy revealed that 8/11 (73%) of patients with HbA1C <2.95%, 111/114 (97%) with HbA1C between 2.95% and 4.55% and 189/215 (88%) of patients with HbA1c >4.55% experienced microbiologic failure. Conclusion Using fractal geometry relationships to drug pharmacokinetics, low weight has profound influence on failure of anti-tuberculosis treatment among patients at risk for diabetes mellitus.
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Affiliation(s)
- Josephine W Mburu
- National Reference Tuberculosis Laboratory, MOH, Kenya.,Jomo Kenyatta University of Agriculture and Technology (JKUAT), Kenya
| | | | - Magiri Ester
- Jomo Kenyatta University of Agriculture and Technology (JKUAT), Kenya
| | - Nyerere Andrew
- Jomo Kenyatta University of Agriculture and Technology (JKUAT), Kenya
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Nagar V, Gour D, Pal DK, Singh AR, Joshi A, Dave L. A study on prevalence of diabetes and associated risk factors among diagnosed tuberculosis patients registered under Revised National Tuberculosis Control Programme in Bhopal District. J Family Med Prim Care 2018; 7:130-136. [PMID: 29915746 PMCID: PMC5958554 DOI: 10.4103/jfmpc.jfmpc_289_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Tuberculosis (TB) and diabetes mellitus (DM) remains a worldwide global public health problem. About 95% of patients with TB live in the low and middle-income countries and more than 70% of patients with DM also live in the same countries, especially in South East Asia. Screening for diabetes in patients with TB will not only ensure early case detection but also better management of diabetes and will lead to better TB treatment outcome. AIMS This study aims to determine the prevalence and its associated factors of diabetes and prediabetes among diagnosed cases of TB patients registered under Revised National Tuberculosis Control Programme (RNTCP) in Bhopal city. SETTINGS AND DESIGN The current study was a longitudinal follow-up study conducted among registered TB patients under RNTCP in all 5 TB units of Bhopal District. SUBJECTS AND METHODS Participants were contacted and interview was conducted after obtaining consent using predesigned and pretested Performa during October 2013-September 2014. STATISTICAL ANALYSIS USED Continuous variable were summarized as frequency, mean, and standard deviation. All variables were analyzed using Chi-square test of significance; P < 0.05 was taken as statically significant. RESULTS Out of the total 662 TB patients, 352 were male and 310 were female. Out of the total, 82 (12.39%) patients were diagnosed as diabetic and 108 (16.3%) were prediabetic. significant association found with six variables which are age, sex, body mass index, type of TB, Category of TB, and smoking. CONCLUSION This study shows feasibility and importance of screening of TB patients.
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Affiliation(s)
- Vivek Nagar
- Department of Community and Family Medicine, All Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Devendra Gour
- Department of Community Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Dinseh Kumar Pal
- Department of Community Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Akash Ranjan Singh
- Department of Community and Family Medicine, All Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Ankur Joshi
- Department of Community and Family Medicine, All Institute of Medical Science, Bhopal, Madhya Pradesh, India
| | - Lokendra Dave
- Department of Community Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
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Nagar V, Prasad P, Gour D, Singh AR, Pal DK. Screening for diabetes among tuberculosis patients registered under revised national tuberculosis control program, Bhopal, India. J Family Med Prim Care 2018; 7:1401-1405. [PMID: 30613532 PMCID: PMC6293918 DOI: 10.4103/jfmpc.jfmpc_14_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Context: Tuberculosis (TB) and diabetes mellitus (DM) remain a global public health problem. India has the largest number of TB cases; in 2015, out of total global annual incidence of 9.6 million TB cases, 2.2 million were estimated from India. There are 62.4 million people with type 2 diabetes and 77 million people with prediabetes in India, and these numbers are projected to increase to 101 million by the year 2030. Diabetes and TB affect each other at many levels. Screening for diabetes in patients with TB will not only help in early case detection but also better management of both comorbidities. Aims: (i) To determine the prevalence of diabetes and prediabetes among diagnosed cases of TB registered under RNTCP in Bhopal district. (ii) To determine additional yield of previously unknown DM and the number needed to screen (NNS) to find out a new case of DM. (iii) To find out the factors associated with diabetes among patients diagnosed with TB registered under RNTCP in Bhopal district. Settings and Design: This study was a cross-sectional study conducted on registered patients with TB under RNTCP in two TB units of Bhopal district. Materials and Methods: Participants were contacted and interview was conducted after obtaining consent using predesigned and pretested performa during the period of 1st October 2014 to 30th March 2015 for a period of 6 months. Statistical Analysis Used: Continuous variable were summarized as frequency, mean, and standard deviation. All variables were analyzed using Chi-square test of significance; P < 0.05 was taken as statically significant. Result: Of the total 528 patients with TB, 296 was male and 232 were female. Of the total, 63 (11.9%) patients were diagnosed as diabetic. NNS to diagnose a new case of DM was 22.1. Significant association was found with six variables which are age, sex, body mass index, type of TB, category of TB, and smoking. Conclusion: This study shows feasibility and importance of screening of patients with TB in existing program settings.
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Affiliation(s)
- Vivek Nagar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Pankaj Prasad
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Devendra Gour
- Department of Community Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
| | - Akash R Singh
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - D K Pal
- Department of Community Medicine, Gandhi Medical College, Bhopal, Madhya Pradesh, India
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Siddiqui AN, Khayyam KU, Siddiqui N, Sarin R, Sharma M. Diabetes prevalence and its impact on health-related quality of life in tuberculosis patients. Trop Med Int Health 2017; 22:1394-1404. [DOI: 10.1111/tmi.12968] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Ali Nasir Siddiqui
- Department of Pharmaceutical Medicine; Faculty of Pharmacy; Hamdard University; New Delhi India
| | - Khalid Umer Khayyam
- Department of Epidemiology & Public health; National Institute of TB and Respiratory Diseases; New Delhi India
| | - Nahida Siddiqui
- Department of Pharmacognosy and Phytochemistry; Faculty of Pharmacy; Hamdard University; New Delhi India
| | - Rohit Sarin
- National Institute of TB and Respiratory Diseases; New Delhi India
| | - Manju Sharma
- Department of Pharmacology; Faculty of Pharmacy; Hamdard University; New Delhi India
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RSSDI clinical practice recommendations for diagnosis, prevention, and control of the diabetes mellitus-tuberculosis double burden. Int J Diabetes Dev Ctries 2017. [DOI: 10.1007/s13410-017-0577-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Philips L, Visser J, Nel D, Blaauw R. The association between tuberculosis and the development of insulin resistance in adults with pulmonary tuberculosis in the Western sub-district of the Cape Metropole region, South Africa: a combined cross-sectional, cohort study. BMC Infect Dis 2017; 17:570. [PMID: 28810840 PMCID: PMC5556352 DOI: 10.1186/s12879-017-2657-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 08/01/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The existence of a bi-directional relationship between tuberculosis (TB) and insulin resistance (IR)/diabetes has been alluded to in literature. Although diabetes has been linked to increased tuberculosis risk, the relationship between tuberculosis as a causative factor for IR remains unclear. The study aimed to determine if an association existed between tuberculosis and IR development in adults with newly diagnosed pulmonary tuberculosis at baseline. It was additionally aimed to document changes in IR status during TB follow-up periods. METHODS This cross-sectional study evaluated ambulatory participants at baseline for IR prevalence via anthropometry, biochemistry and diagnostic IR tests [homeostasis model assessment-IR (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI)]. A prospective cohort sub-section study was additionally performed on approximately half of the baseline study population, who were followed-up at two and five months whilst on tuberculosis treatment. Summary statistics, correlation co-efficients and appropriate analysis of variance were used to describe and analyse data. Participants were excluded if they presented with other forms of tuberculosis, were HIV-positive, obese or had any pre-disposing IR conditions such as diabetes or metabolic syndrome. RESULTS Fifty-nine participants were included from August 2013 until December 2014 (33.95 ± 12.02 years old; 81.4% male). IR prevalence was 25.4% at baseline, determined by a calculated HOMA-IR cut-off point of 2.477. Patients with IR were younger (p = 0.04). Although the difference between IR levels in participants between baseline and follow-up was not significant, a decrease was observed over time. The majority of participants (61.0%) presented with a normal BMI at baseline. Mean baseline values of fasting glucose were within normal ranges (4.82 ± 0.80 mmol/L), whereas increased mean CRP levels (60.18 ± 50.92 mg/L) and decreased mean HDL-cholesterol levels (males: 0.94 ± 0.88 mmol/L; females: 1.14 ± 0.88 mmol/L) were found. CONCLUSIONS The study found an association between tuberculosis and IR development in newly diagnosed pulmonary tuberculosis patients. Although not significant, IR levels decreased over time, which could be indicative of a clinical improvement. A high prevalence of IR amongst young tuberculosis patients therefore highlights the need for early identification in order to facilitate a reversal of IR and prevent possible IR-related complications.
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Affiliation(s)
- Lauren Philips
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Janicke Visser
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Daan Nel
- Centre for Statistical Consultation, Stellenbosch University, Cape Town, South Africa
| | - Renée Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Oni T, Berkowitz N, Kubjane M, Goliath R, Levitt NS, Wilkinson RJ. Trilateral overlap of tuberculosis, diabetes and HIV-1 in a high-burden African setting: implications for TB control. Eur Respir J 2017; 50:50/1/1700004. [PMID: 28729474 PMCID: PMC5538899 DOI: 10.1183/13993003.00004-2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 04/08/2017] [Indexed: 12/12/2022]
Abstract
The diabetes mellitus burden is growing in countries where tuberculosis (TB) and HIV-1 remain major challenges, threatening TB control efforts. This study determined the association between TB and diabetes/impaired glucose regulation in the context of HIV-1. A cross-sectional study was conducted at a TB clinic in Cape Town (South Africa). Participants were screened for diabetes and impaired glucose regulation using fasting plasma glucose, oral glucose tolerance test and glycated haemoglobin (HbA1c). 414 TB and 438 non-TB participants were enrolled. In multivariable analysis, diabetes was associated with TB (OR 2.4, 95% CI 1.3–4.3; p=0.005), with 14% population-attributable risk fraction; however, this association varied by diagnostic test (driven by HbA1c). The association remained significant in HIV-1-infected individuals (OR 2.4, 95% CI 1.1–5.2; p=0.030). A high prevalence of impaired glucose regulation (65.2% among TB cases) and a significant association with TB (OR 2.3, 95% CI 1.6–3.3; p<0.001) was also found. Diabetes and impaired glucose regulation prevalence was high and associated with TB, particularly in HIV-1-infected individuals, highlighting the importance of diabetes screening. The variation in findings by diagnostic test highlights the need for better glycaemia markers to inform screening in the context of TB and HIV-1. DM/TB association is significant in HIV infection, but more accurate glycaemia markers at TB diagnosis are neededhttp://ow.ly/ZXoS30aPz22
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Affiliation(s)
- Tolu Oni
- Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa .,Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Natacha Berkowitz
- Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Mmamapudi Kubjane
- Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Rene Goliath
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Naomi S Levitt
- Division of Diabetes and Endocrinology, Dept of Medicine, Groote Schuur Hospital and Chronic Disease Initiative for Africa, Cape Town, South Africa.,Joint senior authors
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa.,The Francis Crick Institute, London, UK.,Dept of Medicine, Imperial College London, London, UK.,Joint senior authors
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