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Husain NF, Yusoff HM, Hassan NM, Aziz AA. Prevalence of Latent Tuberculosis Infection and its Associated Factors Among Diabetic Patients Availing Primary Health Care in Terengganu State, Malaysia. Oman Med J 2023; 38:e546. [PMID: 38249131 PMCID: PMC10800021 DOI: 10.5001/omj.2023.97] [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: 10/25/2022] [Accepted: 02/20/2023] [Indexed: 01/23/2024] Open
Abstract
Objectives Diabetes mellitus (DM) patients are considered to be at high risk for contracting latent tuberculosis infection (LTBI). This study aimed to determine the prevalence of LTBI and its associated factors among diabetic patients attending primary care clinics in Terengganu state, Malaysia. Methods This cross-sectional study was conducted among diabetic patients attending 11 health clinics in the Terengganu region from June 2017 to November 2018. The selected participants were administered a tuberculin skin test (TST). Simple and multivariate logistic regressions were applied to evaluate the significant associated factors of LTBI. Results The total number of participants were 703 DM patients. The factors found associated with LTBI were poor diabetic control status (odds ratio (OR) = 8.53; p=0.008), being a healthcare worker (OR = 7.91; p=0.001), history of contact with TB patients (OR = 5.69; p < 0.001), bronchial asthma (OR = 5.28; p=0.019), coronary heart disease (OR = 3.45; p=0.026), and nephropathy (OR = 0.34; p=0.040). The presence of LTBI was found in 34 (4.8%) participants. Conclusions At 4.8%, the prevalence of LTBI among DM patients in Terengganu is relatively low. Diabetics with poorly controlled blood glucose levels, nephropathy, bronchial asthma, coronary heart disease, history of TB patient contact, or working in the healthcare profession should be periodically tested for LTBI.
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Affiliation(s)
- Nur Fatini Husain
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Harmy Mohamed Yusoff
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Nurulhuda Mat Hassan
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
| | - Aniza Abdul Aziz
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
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Yang H, Wu F, Gui M, Cheng Y, Zhang L. The role of medication adherence in the association between depressive symptoms and quality of life in older adults with type 2 diabetes mellitus. BMC Geriatr 2023; 23:196. [PMID: 36997851 PMCID: PMC10064516 DOI: 10.1186/s12877-023-03929-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND At present, the role of medication adherence in the association between depressive symptoms and quality of life (QOL) in older adults with type 2 diabetes mellitus (T2DM) was unclear. The purpose of this study was to explore the associations among depressive symptoms, medication adherence and QOL in older adults with T2DM. METHODS In this cross-sectional study, 300 older adults with T2DM from the First Affiliated Hospital of Anhui Medical University were enrolled. Among them, 115 patients had depressive symptoms and 185 had no depressive symptoms. Univariate linear regression analysis was conducted to identify possible covariates. Univariate and multivariable linear regression analyses were performed to explore the associations between depressive symptoms and medication adherence or QOL in older adults with T2DM. Multiplicative interaction analysis was evaluated whether there was interaction effect between medication adherence and depressive symptoms on QOL of patients. Mediating effect analysis was used to analyze the medication effect of medication adherence on depressive symptoms and QOL in older adults with T2DM. RESULTS Decreased medication adherence was observed in patients with depressive symptoms (β = -0.67, 95%CI: -1.10, -0.24) after adjusting for covariates. Depressive symptoms were associated with decreased QOL in older adults with T2DM (β = -5.99, 95%CI: -7.56, -4.42). The mediating analysis revealed that depressive symptoms were associated with decreased medication adherence (β = -0.67, 95%CI: -1.09, -0.25). Medication adherence was linked with increased QOL of older adults with T2DM (β = 0.65, 95%CI: 0.24, 1.06). Depressive symptoms were correlated with decreased QOL of older adults with T2DM (β = -5.56, 95%CI: -7.10, -4.01). The percentage mediated by medication adherence on depressive symptoms and QOL in older adults with T2DM was 10.61%. CONCLUSION Medication adherence might mediate depressive symptoms and QOL of older adults with T2DM, which might provide a reference for the improvement of QOL of these patients.
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Affiliation(s)
- Hao Yang
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 of Jixi Road, Shushan District, Hefei, 230032, Anhui, China.
| | - Fangtuan Wu
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 of Jixi Road, Shushan District, Hefei, 230032, Anhui, China
| | - Mingdong Gui
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 of Jixi Road, Shushan District, Hefei, 230032, Anhui, China
| | - Yuwei Cheng
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 of Jixi Road, Shushan District, Hefei, 230032, Anhui, China
| | - Li Zhang
- Department of Geriatric Endocrinology, The First Affiliated Hospital of Anhui Medical University, No.218 of Jixi Road, Shushan District, Hefei, 230032, Anhui, China
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Borges MASB, Cunha ID, Candini LH, de Souza VA, da Costa PSS. Clinical-Epidemiological Characteristics and Outcomes of Latent Tuberculosis Treatment at a Tertiary Center in Central-West Brazil from 2017 to 2019. Trop Med Infect Dis 2022; 7:tropicalmed7120432. [PMID: 36548687 PMCID: PMC9787027 DOI: 10.3390/tropicalmed7120432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/26/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Detailed information concerning latent tuberculosis infection (LTBI) and treatment outcomes is scarce in Brazil. This retrospective cross-sectional study aimed to describe LTB treatment (LTBT) at a tertiary center in Central-West Brazil from 2017 to 2019. We recommended the use of LTBTs before the implementation of a rifapentine-isoniazid (3HP) regimen in Brazil. We conducted a descriptive analysis using chi-square or t-tests to assess differences in the proportions and means. Of 79 notified adult patients (males, 68%; median age, 40 (interquartile range, 30-51) years), most people were living with human immunodeficiency virus (PLHIV) (82%) or receiving immunosuppressant medication (15%), and 92% were receiving their first treatment. Isoniazid (INH) for 6-9 months had previously been proposed for 95% of the patients, with only 35% completeness. Four patients treated with rifampicin (4RMP) completed the regimen (p = 0.009). Adverse events occurred in 19% of the patients. In this Brazilian tertiary center, the target population for LTBT were young PLHIV patients under immunosuppression with low education levels. However, the INH monotherapy dropout rate was 65%. Therefore, shorter courses, such as 3HP and 4RMP, are promising alternatives. Behavioral aspects, education level, and regimen length can influence the course completion, and further studies are required to evaluate the 3HP regime in Brazil.
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Affiliation(s)
- Moara Alves Santa Bárbara Borges
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiania 74605-050, Brazil
- Clinical Hospital, Federal University of Goiás, Empresa Brasileira de Serviços Hospitalares, Goiania 74605-050, Brazil
- Correspondence: ; Tel.: +55-62-32698377
| | - Iago Dib Cunha
- Medicine School, Federal University of Goiás, Goiania 74605-050, Brazil
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Torres AV, Corrêa RDS, Bevilacqua MDF, do Prado LCF, Bandeira FMGDC, Rodrigues LS, Gomes MB. Screening of latent tuberculosis infection among patients with diabetes mellitus from a high-burden area in Brazil. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:914574. [PMID: 36992754 PMCID: PMC10012069 DOI: 10.3389/fcdhc.2022.914574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 07/05/2022] [Indexed: 06/19/2023]
Abstract
Although several cohort studies have raised the important association between diabetes mellitus (DM) and latent tuberculosis infection (LTBI), evidences are limited and controversial. Furthermore, it is well documented that the poor glycemic control may exacerbate the risk for active TB. Thus, the monitoring of diabetic patients living in high-incidence areas for TB is an important concern in views of available diagnostic tests for LTBI. In this cross-sectional study, we estimate the association of DM and LTBI among diabetic patients classified as type-1 DM (T1D) or type-2 DM (T2D) living in Rio de Janeiro, RJ, Brazil - considered a high TB burden region of these country. Non-DM volunteers were included as endemic area healthy controls. All participants were screened for DM using glycosylated-hemoglobin (HbA1c) and for LTBI using the QuantiFERON-TB Gold in Tube (QFT-GIT). Demographic, socioeconomic, clinical and laboratorial data were also assessed. Among 553 included participants, 88 (15.9%) had QFT-GIT positive test, of which 18 (20.5%) were non-DM, 30 (34.1%) T1D and 40 (45.4%) T2D. After adjustments for potential baseline confounders, age, self-reported non-white skin color and an active TB case in the family were significantly associated with LTBI among the studied population by using a hierarchical multivariate logistic regression analysis. Additionally, we verified that T2D patients were able to produce significant increased interferon-gamma (IFN-γ) plasma levels in response to Mycobacterium tuberculosis-specific antigens, when compared to non-DM individuals. Altogether, our data showed an increased prevalence of LTBI among DM patients, albeit non-statistically significant, and point out to important independent factors associated with LTBI, which deserve attention in monitoring patients with DM. Moreover, QFT-GIT test seems to be a good tool to screening LTBI in this population, even in a high TB burden area.
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Affiliation(s)
- Amanda Vital Torres
- Diabetes Unit, Department of Internal Medicine, Faculty of Medical Science, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
- Laboratory of Immunopathology, Department of Pathology and Laboratories, Faculty of Medical Science, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - Raquel da Silva Corrêa
- Laboratory of Immunopathology, Department of Pathology and Laboratories, Faculty of Medical Science, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - Maria de Fátima Bevilacqua
- Diabetes Unit, Department of Internal Medicine, Faculty of Medical Science, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - Luana Cristina França do Prado
- Laboratory of Immunopathology, Department of Pathology and Laboratories, Faculty of Medical Science, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - Flavia Miranda Gomes de Constantino Bandeira
- Hematology and Transfusion Unit, Department of Internal Medicine, Faculty of Medical Science, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
- Herbert de Souza Hemotherapy Service, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - Luciana Silva Rodrigues
- Laboratory of Immunopathology, Department of Pathology and Laboratories, Faculty of Medical Science, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
| | - Marilia Brito Gomes
- Diabetes Unit, Department of Internal Medicine, Faculty of Medical Science, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ, Brazil
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Dias VL, Storrer KM. Prevalence of latent tuberculosis infection among patients with interstitial lung disease requiring immunosuppression. J Bras Pneumol 2022; 48:e20210382. [PMID: 35352793 PMCID: PMC8963748 DOI: 10.36416/1806-3756/e20210382] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/22/2022] [Indexed: 12/12/2022] Open
Abstract
Objective To characterize the prevalence of latent tuberculosis infection (LTBI) in patients with interstitial lung diseases (ILDs) requiring immunosuppression. Only 5 to 10% of individuals infected with Mycobacterium tuberculosis develop tuberculosis, and certain groups of patients have an increased risk of illness, such as the immunocompromised. Patients with ILDs are frequently treated with immunosuppressants and, therefore, might have a higher risk of developing the disease. Methods Prospective study conducted at the ILD reference center of the Federal University of Paraná from January 2019 to December 2020. The screening of LTBI was performed with the use of the tuberculin skin test (TST). Results The sample consisted of 88 patients, of whom 64.8% were women, with a mean age of 61.4 years. The most frequent diagnoses were autoimmune rheumatic disease ILD (38.6%) and hypersensitivity pneumonitis (35.2%). The most common immunosuppressant in use at the time of the TST was prednisone, either in combination with mycophenolate (19.3%) or alone (17.1%). The majority of participants had fibrotic lung disease, characterized by a reticular interstitial pattern on chest computed tomography (79.5%) and moderate to severe functional impairment (mean FVC 69.2%). A prevalence of LTBI of 9.1% (CI 95%, 2.1%-15.1%) was found, with a TST median of 13. Conclusion Patients with ILD who are treated with immunosuppressants are not commonly screened for LTBI, despite being under a greater risk of progression to active disease. This study suggests the need for a more cautious approach to these patients.
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Song B, Zhao X, Yao T, Lu W, Zhang H, Liu T, Liu C, Wang K. Triglyceride Glucose-Body Mass Index and Risk of Incident Type 2 Diabetes Mellitus in Japanese People With Normal Glycemic Level: A Population-Based Longitudinal Cohort Study. Front Endocrinol (Lausanne) 2022; 13:907973. [PMID: 35909552 PMCID: PMC9336540 DOI: 10.3389/fendo.2022.907973] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/21/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND It has been proved that triglyceride glucose-body mass index (TyG-BMI) is a readily available and clinically significant indicator of insulin resistance (IR). Nevertheless, the association between TyG-BMI and incident Type 2 diabetes mellitus (T2DM) remains uncertain. This study aimed to study the relationship between TyG-BMI and T2DM and explore the predictive characteristics of TyG-BMI. METHODS Our study was conducted as a longitudinal cohort study. 8,430 men and 7,034 women were enrolled and analyzed. They were both non-diabetic subjects with normal glycemic levels. Follow-up lasted for 13 years, from 1994 to 2016. To make the number of TyG-BMI in each group similar, the subjects were divided into four groups with 3866 subjects in each group. RESULTS During the 13-year follow-up period, 373 subjects were diagnosed with incident T2DM. Our multivariate Cox regression analysis revealed that TyG-BMI was an independent predictor of incident T2DM. In addition, our research identified four specific groups, young people (18-44 years old), women, the non-hypertensive population and non-drinkers were at significantly higher risk of developing TyG-BMI-related diabetes (P-interaction< 0.05). The best threshold TyG-BMI for predicting incident T2DM was 197.2987 (area under the curve 0.7738). CONCLUSIONS Our longitudinal cohort study demonstrated the positive correlation between baseline TyG-BMI and risk of incident T2DM in Japanese with normal glycemic levels, and this risk was significantly higher in the young people, women, the non-hypertensive population and non-drinkers.
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Affiliation(s)
| | | | | | | | | | | | | | - Kun Wang
- *Correspondence: Chengyun Liu, ; Kun Wang,
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