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Jackson-Morris A, Masyuko S, Morrell L, Kataria I, Kocher EL, Nugent R. Tackling syndemics by integrating infectious and noncommunicable diseases in health systems of low- and middle-income countries: A narrative systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003114. [PMID: 38753811 PMCID: PMC11098501 DOI: 10.1371/journal.pgph.0003114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 03/25/2024] [Indexed: 05/18/2024]
Abstract
The co-occurrence of infectious diseases (ID) and non-communicable diseases (NCD) is widespread, presenting health service delivery challenges especially in low-and middle-income countries (LMICs). Integrated health care is a possible solution but may require a paradigm shift to be successfully implemented. This literature review identifies integrated care examples among selected ID and NCD dyads. We searched PubMed, PsycINFO, Cochrane Library, CINAHL, Web of Science, EMBASE, Global Health Database, and selected clinical trials registries. Eligible studies were published between 2010 and December 2022, available in English, and report health service delivery programs or policies for the selected disease dyads in LMICs. We identified 111 studies that met the inclusion criteria, including 56 on tuberculosis and diabetes integration, 46 on health system adaptations to treat COVID-19 and cardiometabolic diseases, and 9 on COVID-19, diabetes, and tuberculosis screening. Prior to the COVID-19 pandemic, most studies on diabetes-tuberculosis integration focused on clinical service delivery screening. By far the most reported health system outcomes across all studies related to health service delivery (n = 72), and 19 addressed health workforce. Outcomes related to health information systems (n = 5), leadership and governance (n = 3), health financing (n = 2), and essential medicines (n = 4)) were sparse. Telemedicine service delivery was the most common adaptation described in studies on COVID-19 and either cardiometabolic diseases or diabetes and tuberculosis. ID-NCD integration is being explored by health systems to deal with increasingly complex health needs, including comorbidities. High excess mortality from COVID-19 associated with NCD-related comorbidity prompted calls for more integrated ID-NCD surveillance and solutions. Evidence of clinical integration of health service delivery and workforce has grown-especially for HIV and NCDs-but other health system building blocks, particularly access to essential medicines, health financing, and leadership and governance, remain in disease silos.
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Affiliation(s)
- Angela Jackson-Morris
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Sarah Masyuko
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Lillian Morrell
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
- Wilson Sheehan Lab for Economic Opportunities, University of Notre Dame, Notre Dame, Indiana, United States of America
| | - Ishu Kataria
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Erica L. Kocher
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
- Emory University, Emory University, Atlanta, Georgia, United States of America
| | - Rachel Nugent
- Center for Global Noncommunicable Diseases, RTI International, Research Triangle Park, North Carolina, United States of America
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Burugina Nagaraja S. TB operational research in India - Gaps and pragmatic solutions. Indian J Tuberc 2024; 71:3-6. [PMID: 38296387 DOI: 10.1016/j.ijtb.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 10/24/2023] [Accepted: 10/31/2023] [Indexed: 02/07/2024]
Abstract
Operational research (OR) plays a pivotal role in the management and improvement of national tuberculosis (TB) programs in India. This article underscores the indispensable value of OR in optimizing resource allocation, enhancing treatment protocols, improving diagnostics, ensuring patient adherence, monitoring program performance, and informing policy decisions. However, it is vital to address existing gaps in the operational research mechanisms of the National Tuberculosis Elimination Program (NTEP) in India to maximize its effectiveness. In conclusion, India's healthcare system can significantly benefit from the systematic implementation of operational research, especially in the context of TB control. To achieve this, India must continue to invest in research infrastructure, enhance research capacity among healthcare professionals, and promote collaboration among researchers, healthcare providers, and policymakers. By doing so, India can harness the power of operational research to lead the fight against TB and enhance the well-being of its citizens.
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Affiliation(s)
- Sharath Burugina Nagaraja
- ESIC Medical College and Post Graduate Institute of Medical Sciences and Research, Bengaluru, Karnataka, India.
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Nunemo MH, Gidebo KD, Woticha EW, Lemu YK. Integration Challenges and Opportunity of Implementing Non-Communicable Disease Screening Intervention with Tuberculosis Patient Care: A Mixed Implementation Study. Risk Manag Healthc Policy 2023; 16:2609-2633. [PMID: 38045564 PMCID: PMC10693204 DOI: 10.2147/rmhp.s432943] [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: 08/25/2023] [Accepted: 11/18/2023] [Indexed: 12/05/2023] Open
Abstract
Background Despite the comorbidity, early detection and treatment of the two diseases are highly recommended; however, a few pilot studies were conducted, which are mainly focused on diabetes mellitus screening and the integration opportunity and challenges were not known. The study aimed to identify integrated implementation challenges and opportunities of non-communicable disease and risk factors screening intervention with tuberculosis patient care. Methods A mixed implementation study design was used. Data were collected from a sample of 443 tuberculosis patients, 21 key informants and facility observations. For quantitative data, descriptive statistics for proportion were summarized in tables and figures. Four distinct implementation frame was adapted for thematic analysis of audio recordings, daily verbatim transcription, and descriptive field notes. Results The prevalence of hypertension and diabetes mellitus among tuberculosis patients were 6.55% and 5.64%, respectively. Totally 9 subthemes and 21 new codes were developed, of which 13 and 8 new codes were developed for integrated implementation challenges and opportunities, respectively. The absence of medical equipment, skill and knowledge training, record and report system, cooperative integration, feedback, referral system, shortage of supporting agencies, and services not free were external challenges, whereas lack of trained health workers, focal persons, and increased workload and absence of awareness creation were internal challenges. Despite the challenges, the presence of health extension programs, non-governmental organizations, community health care insurance and associations for diabetes mellitus were external opportunities. Availability of assigned focal persons, trained stakeholders, guidelines, information systems and compatible tuberculosis program structure were internal opportunities. Conclusion The majority of TB patients were not comorbid with NCDs. We build a favourable system for integrated implementation developing an integration platform and structural authority at a different organization by addressing identified challenges and applying facilitators is crucial.
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Affiliation(s)
| | - Kassa Daka Gidebo
- Department of Public Health, Wolaita Sodo University, Wolaita, South Region, Ethiopia
| | | | - Yohannes Kebede Lemu
- Department of Health, Behaviour and Society, Jimma University, Jimma, Oromia Region, Ethiopia
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Makuka GJ, Balandya E, Munseri P. Burden of active pulmonary tuberculosis among patients with diabetes in Dar es Salaam, Tanzania: a cross-sectional study. BMJ Open 2022; 12:e065969. [PMID: 36424102 PMCID: PMC9693890 DOI: 10.1136/bmjopen-2022-065969] [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: 11/25/2022] Open
Abstract
OBJECTIVES We aimed to determine the prevalence, associated factors and describe the chest radiographic findings for active pulmonary tuberculosis (TB) among patients with diabetes mellitus (DM) attending a diabetic clinic in Tanzania. DESIGN Cross-sectional study. SETTING A diabetic clinic at Temeke Regional Referral Hospital in Dar es salaam, Tanzania. PARTICIPANTS Patients with diabetes. MAIN OUTCOME MEASURES The prevalence and factors associated with active TB in patients with DM. RESULTS Among 623 patients with DM screened, 11 (1.8%); 95% CI 0.9 to 3.1, had active TB of which 6 (54.5%) were GeneXpert positive and 5 (45.5%) were diagnosed based on clinical symptoms and suggestive chest radiographs. The risk of active TB was lower in patients aged 45-64 years compared with age below 45 years (adjusted prevalence ratio (aPR) 0.39, 95% CI (0.11 to 0.42), p=0.001) and in patients with normal chest examination findings compared with patients with crackles or bronchial breathing sounds (aPR 0.02, 95% CI (0.01 to 0.15), p<0.01). The predominant chest radiographic findings were opacification 100% mainly in the upper and mid-lung zones. CONCLUSION Diabetics should be screened for pulmonary TB, particularly among individuals aged 45 years and below with crackles or bronchial breathing on auscultation of the chest. High index of suspicion could help in the early detection and control of TB.
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Affiliation(s)
- Gerald Jamberi Makuka
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emmanuel Balandya
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
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The challenge of tuberculosis diagnosis and management in the era of the COVID-19 pandemic and diabetes mellitus. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2022. [DOI: 10.5812/archcid-128743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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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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Antonio-Arques V, Franch-Nadal J, Caylà JA. Diabetes and tuberculosis: A syndemic complicated by COVID-19. ACTA ACUST UNITED AC 2021; 157:288-293. [PMID: 34541325 PMCID: PMC8433042 DOI: 10.1016/j.medcle.2021.04.006] [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: 01/15/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
Tuberculosis (TB) is the leading cause of infectious mortality in the world, affecting mainly developing countries (DC), while diabetes (DM) is one of the most prevalent chronic diseases. This review analyzes the fact that diabetes is currently an important risk factor for developing TB, also presenting more complicated TB, more relapses and higher mortality. The DCs and the fourth world of the large cities are those with the highest incidence of TB and an increase in DM, which will make it difficult to control tuberculosis disease. At the same time, the COVID-19 pandemic is complicating the management of both diseases due to the difficulty of access to control and treatment and the worsening of socioeconomic inequalities. It is necessary to establish a bidirectional screening for TB and DM and promote recommendations for the joint management of both diseases.
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Affiliation(s)
- Violeta Antonio-Arques
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain.,Equip d'Atenció Primària (EAP) Bordeta Magòria, Institut Català de la Salut, Barcelona, Spain
| | - Josep Franch-Nadal
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain.,Equip d'Atenció Primària (EAP) Raval Sud - Drassanes, Institut Català de la Salut, Barcelona, Spain
| | - Joan A Caylà
- Fundación de la Unidad de Investigación en Tuberculosis de Barcelona, Barcelona, Spain
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Chen Z, Liu Q, Song R, Zhang W, Wang T, Lian Z, Sun X, Liu Y. The association of glycemic level and prevalence of tuberculosis: a meta-analysis. BMC Endocr Disord 2021; 21:123. [PMID: 34134685 PMCID: PMC8207612 DOI: 10.1186/s12902-021-00779-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 06/01/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Diabetes is a well-known risk factor for tuberculosis and poorly glycemic control may increase the risk of tuberculosis. We performed a meta-analysis to explore the association of glycemic control in diabetic patients and their tuberculosis prevalence. METHODS We included observational studies that investigated the prevalence of tuberculosis associated with glycemic control. The markers of glycated hemoglobin A1c (HbA1c) and fasting plasma glucose were used to evaluate the exposure of interest in the study. We searched related articles in PubMed, EMBASE and Web of Science through 14 December 2019. The Newcastle-Ottawa scale was used to assess the risk of bias of included studies. RESULTS Seventeen studies (four cohort studies, five case-control studies and eight cross-sectional studies) were included, involving 1,027,074 participants. The meta-analysis found the pooled odds ratio of prevalent tuberculosis increased a 2.05-fold (95%CI: 1.65, 2.55) for the patients with HbA1c ≥7.0% compared to those with HbA1c concentration < 7.0%. Furthermore, we found the mean of HbA1c was higher in the diabetes mellitus with tuberculosis group than the diabetes-only group (P = 0.002). In the sensitivity analysis, the finding remains consistent. CONCLUSION Our study provides the evidence that poorly controlled diabetes in diabetics may be associated with increased prevalence of tuberculosis. More efforts should focus on screening tuberculosis in uncontrolled diabetes.
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Affiliation(s)
- Zhifei Chen
- Wuhan Pulmonary Hospital, Wuhan, Hubei, China.
| | - Qi Liu
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ranran Song
- Department of Maternal and Child Health and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Wuhan, Hubei, China
| | - Wenxin Zhang
- Key Laboratory of Environment and Health, Ministry of Education and Ministry of Environmental Protection, and State Key Laboratory of Environmental Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | | | - Zhan Lian
- Wuhan Pulmonary Hospital, Wuhan, Hubei, China
| | - Xuezhi Sun
- Wuhan Pulmonary Hospital, Wuhan, Hubei, China
| | - Yanli Liu
- Wuhan Pulmonary Hospital, Wuhan, Hubei, China
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Antonio-Arques V, Franch-Nadal J, Caylà JA. Diabetes and tuberculosis: a syndemic complicated by COVID-19. Med Clin (Barc) 2021; 157:288-293. [PMID: 34049681 PMCID: PMC8101986 DOI: 10.1016/j.medcli.2021.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 01/16/2023]
Abstract
Tuberculosis (TB) is the leading cause of infectious mortality in the world, affecting mainly developing countries (DC), while diabetes (DM) is one of the most prevalent chronic diseases. This review analyzes the fact that diabetes is currently an important risk factor for developing TB, also presenting more complicated TB, more relapses and higher mortality. The DCs and the fourth world of the large cities are those with the highest incidence of TB and an increase in DM, which will make it difficult to control tuberculosis disease. At the same time, the COVID-19 pandemic is complicating the management of both diseases due to the difficulty of access to control and treatment and the worsening of socioeconomic inequalities. It is necessary to establish a bidirectional screening for TB and DM and promote recommendations for the joint management of both diseases.
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Affiliation(s)
- Violeta Antonio-Arques
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España; Equip d'Atenció Primària (EAP) Bordeta Magòria, Institut Català de la Salut, Barcelona, España
| | - Josep Franch-Nadal
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España; Equip d'Atenció Primària (EAP) Raval Sud - Drassanes, Institut Català de la Salut, Barcelona, España.
| | - Joan A Caylà
- Fundación de la Unidad de Investigación en Tuberculosis de Barcelona, Barcelona, España
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Hewage S, Somasundaram N, Ratnasamy V, Ranathunga I, Fernando A, Perera I, Perera U, Vidanagama D, Cader M, Fernando P, Pallewatte N, Rathnayaka L, Jayawardhana D, Danansuriya M, Gunawardena N. Active screening of patients with diabetes mellitus for pulmonary tuberculosis in a tertiary care hospital in Sri Lanka. PLoS One 2021; 16:e0249787. [PMID: 33831095 PMCID: PMC8031956 DOI: 10.1371/journal.pone.0249787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/24/2021] [Indexed: 11/19/2022] Open
Abstract
End TB strategy by the WHO suggest active screening of high-risk populations for tuberculosis (TB) to improve case detection. Present study generates evidence for the effectiveness of screening patients with diabetes mellitus (DM) for Pulmonary TB (PTB). A study was conducted among 4548 systematically recruited patients over 45 years attending DM clinic at the National Hospital of Sri Lanka. The study units followed an algorithm specifying TB symptom and risk factor screening for all, followed by investigations and clinical assessments for those indicated. Bacteriologically confirmed or clinically diagnosed PTB were presented as proportions with 95% CI. Mean (SD) age was 62·5 (29·1) years. Among patients who completed all indicated steps of algorithm, 3500 (76·9%) were investigated and 127 (2·8%) underwent clinical assessment. Proportion of bacteriologically confirmed PTB patients was 0·1% (n = 6,95%CI = 0·0-0·3%). None were detected clinically. Analysis revealed PTB detection rates among males aged ≥60 years with HbA1c ≥ 8 to be 0·4% (n = 2, 95%CI = 0·0-1·4%). The study concludes that active screening for PTB among all DM patients at clinic settings in Sri Lanka, to be non-effective measure to enhance TB case finding. However, the sub-category of diabetic males with uncontrolled diabetics who are over 60 years of age is recommended as an option to consider for active screening for PTB.
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Affiliation(s)
- Sumudu Hewage
- National Program for Tuberculosis Control and Chest Diseases, Ministry of Health, Colombo, Sri Lanka
| | - Noel Somasundaram
- Diabetes and Endocrinology Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Vithiya Ratnasamy
- Diabetes and Endocrinology Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Ishara Ranathunga
- Diabetes and Endocrinology Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka
| | - Amitha Fernando
- National Program for Tuberculosis Control and Chest Diseases, Ministry of Health, Colombo, Sri Lanka
| | | | - Udara Perera
- Health Informatics Unit, Ministry of Health, Colombo, Sri Lanka
| | | | - Mizaya Cader
- National Program for Tuberculosis Control and Chest Diseases, Ministry of Health, Colombo, Sri Lanka
| | - Poorna Fernando
- Health Informatics Unit, Ministry of Health, Colombo, Sri Lanka
| | - Nirupa Pallewatte
- National Program for Tuberculosis Control and Chest Diseases, Ministry of Health, Colombo, Sri Lanka
| | - Lakmal Rathnayaka
- National Program for Tuberculosis Control and Chest Diseases, Ministry of Health, Colombo, Sri Lanka
| | - Dushani Jayawardhana
- National Program for Tuberculosis Control and Chest Diseases, Ministry of Health, Colombo, Sri Lanka
| | | | - Nalika Gunawardena
- World Health Organization Country Office for Sri Lanka, Colombo, Sri Lanka
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Co-existence of diabetes and TB among adults in India: a study based on National Family Health Survey data. J Biosoc Sci 2020; 53:758-772. [PMID: 32959732 DOI: 10.1017/s0021932020000516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Multiple studies suggest that diabetes mellitus (DM) is a potential risk factor for tuberculosis (TB) development and treatment, especially in low- and middle-income countries. The study aimed to test concomitancy between DM and TB among adults in India. Data were from the 2015-16 National Family Health Survey (NFHS-4). The study sample comprised 107,575 men aged 15-54 and 677,292 women aged 15-49 for which data on DM status were available in the survey. The association between state-level prevalence of TB and DM was examined and robust Poisson regression analysis applied to examine the effect of DM on TB. A high prevalence of TB was observed among individuals with diabetes in India in 2015-16. A total of 866 per 100,000 men and 405 per 100,000 women who self-reported having diabetes also had TB; among those who self-reported not having diabetes the ratios were 407 per 100,000 men and 241 per 100,000 women. The risk of having TB among those who self-reported having DM was higher for both men (2.03, 95% CI: 1.26, 3.28) and women (1.79, 95% CI: 1.48, 2.49) than for those who did not self-report having DM. Adults who were diagnosed with diabetes (including pre-diabetes) also had a higher rate of TB (477 per 100,000 men and 331 per 100,000 women) than those who were not diagnosed (410 per 100,000 men and 239 per 100,000 women). Adults from poor families, with lower BMIs, lower levels of literacy and who were not working had a higher risk of TB-DM co-morbidity. The state-level pattern of co-morbidity, the under-reporting of DM (undiagnosed) and TB stigmatization are discussed. The study confirms that diabetes is an important co-morbid feature with TB in India, and reinforces the need to raise awareness on screening for the co-existence of DM and TB with integrated health programmes for the two conditions.
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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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Dabhi PA, Thangakunam B, Gupta R, James P, Thomas N, Naik D, Christopher DJ. Screening for prevalence of current TB disease and latent TB infection in type 2 diabetes mellitus patients attending a diabetic clinic in an Indian tertiary care hospital. PLoS One 2020; 15:e0233385. [PMID: 32502176 PMCID: PMC7274437 DOI: 10.1371/journal.pone.0233385] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 05/03/2020] [Indexed: 12/01/2022] Open
Abstract
Background Diabetes triples the risk of developing tuberculosis (TB). This study was designed to determine the prevalence of past and current TB disease and Latent TB infection (LTBI) in type 2 Diabetes Mellitus (NIDDM) patients. Design This was a prospective descriptive study on all NIDDM patients attending a Diabetic clinic. Detailed history, included details of previous history of TB (Past TB)and symptoms of active TB and a thorough physical exam was also done. When clinical suspicion of TB was present, appropriate investigations were carried out to diagnose ‘Current TB’. Subsequently, 200 consecutive patients who were negative for Past and Current TB were screened for Latent TB infection (LTBI) by tuberculin skin test. Results Of 1000 NIDDM patients enrolled, 43(4.3%) had Past TB. Of remaining 957 patients, 50 were evaluated for New TB on the basis of suggestive symptoms and 10(1%) patients were confirmed to have Current TB. Risk factors for Past or Current TB ‘DM-TB’ in comparison with ‘DM Only’ group were; male sex (72% VS 57%; P = 0.033), manual laborer (28% VS 15%; P = 0.012), smoking (26% VS 14%; P = 0.015), alcohol consumption (23% VS 9%; P<0.001)& being on treatment with Insulin (40% VS 20%; P<0.001). There was a protective effect with being a home maker (17% VS 37%; P = 0.034&overweightstatus (53% VS 71%; P = 0.004). Of the 200 patient without Past or Current TB, who were screened for LTBI, 96(48%) patients were found to have LTBI. Male sex was the only significant risk factor for LTBI (72% VS 59%; P = 0.05). Conclusion Past and Current TB was substantial in patients attending a Diabetic Clinic. Active symptom screening for TB in these clinics could lead to increase in case detection and earlier diagnosis.
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Affiliation(s)
| | | | - Richa Gupta
- Department of Pulmonary Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Prince James
- Department of Respiratory Medicine, Christian Medical College, Vellore, Tamil Nadu, India
| | - Nihal Thomas
- Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
| | - Dukhabandhu Naik
- Department of Endocrinology, Jawaharlal Institute of postgraduate medical education and Research (JIPMER), Pondicherry, India
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Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Hosseini Fard H, Ghojazadeh M. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect 2020; 10:98-115. [PMID: 32296622 PMCID: PMC7146037 DOI: 10.34172/hpp.2020.18] [Citation(s) in RCA: 295] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/26/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Diabetes is referred to a group of diseases characterized by high glucose levels in blood. It is caused by a deficiency in the production or function of insulin or both, which can occur because of different reasons, resulting in protein and lipid metabolic disorders. The aim of this study was to systematically review the prevalence and incidence of type 1 diabetes in the world. Methods: A systematic search of resources was conducted to investigate the prevalence and incidence of type 1 diabetes in the world. The databases of Medline (via PubMed and Ovid),ProQuest, Scopus, and Web of Science from January 1980 to September 2019 were searched to locate English articles. The located articles were screened in multiple levels of title, abstract,and full-text and final studies that met the inclusion criteria were retrieved and included in the study. Results: From 1202 located articles, 193 studies were included in this systematic review. The results of meta-analysis showed that the incidence of type 1 diabetes was 15 per 100,000 people and the prevalence was 9.5% (95% CI: 0.07 to 0.12) in the world, which was statistically significant. Conclusion: According to the results, the incidence and prevalence of type 1 diabetes are increasing in the world. As a result, insulin will be difficult to access and afford, especially in underdeveloped and developing countries.
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Affiliation(s)
- Majid Mobasseri
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Shirmohammadi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tarlan Amiri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nafiseh Vahed
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Hosseini Fard
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
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Awad SF, Critchley JA, Abu-Raddad LJ. Epidemiological impact of targeted interventions for people with diabetes mellitus on tuberculosis transmission in India: Modelling based predictions. Epidemics 2019; 30:100381. [PMID: 31846721 DOI: 10.1016/j.epidem.2019.100381] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 12/01/2019] [Accepted: 12/01/2019] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) is a leading driver of tuberculosis (TB) disease in TB-DM burdened countries. We aimed to assess the impact on TB disease of several intervention strategies targeting people with DM in India. METHODS A previously validated TB-DM mathematical model was extended to include interventions targeting DM individuals. The model stratified the population by age, DM status, TB infection status and stage, TB disease form, treatment, recovery, and intervention status. RESULTS By 2050, different TB vaccination strategies (coverage of 50 % and vaccine efficacies ranging between 50 %-60 %) reduced TB incidence and mortality rates by 4.5 %-20.8 % and 4.1 %-22.1 %, respectively, and averted 3.1 %-12.8 % of TB disease cases in the total population. Number of vaccinations needed to avert one TB case (effectiveness) was 14-105. Varying the coverage levels of latent TB treatment (coverage of 50 %-80 % and drug effectiveness of 90 %) reduced TB incidence and mortality rates by 7.1 %-11.3 % and 8.2 %-13.0 %, respectively, averting 4.2 %-6.7 % of TB cases, with effectiveness of 38-40. Different scenarios for dual and concurrent treatment of those with TB and DM, reduced TB incidence and mortality rates by 0.1 %-0.4 % and 1.3 %-4.8 %, respectively, averting 0.1 %-0.2 % of TB cases, with effectiveness of 28-107. Different scenarios for managing and controlling DM (regardless of TB status) reduced TB incidence and mortality rates by 4.5 %-16.5 % and 6.5 %-22.2 %, respectively, averting 2.9 %-10.8 % of TB cases, with effectiveness of 6-24. CONCLUSION Gains can be attained by targeting DM individuals with interventions to reduce TB burden. Most strategies were effective with <50 intervention doses needed to avert one TB disease case, informing key updates of current treatment guidelines.
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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.
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, London, UK
| | - 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, NY, USA; College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar
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Leal ML, Maciel ELN, Cade NV. Factors associated with tuberculosis in a population of diabetics: A case-control study. CIENCIA & SAUDE COLETIVA 2019; 24:3247-3256. [PMID: 31508745 DOI: 10.1590/1413-81232018249.30392017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 02/09/2018] [Indexed: 01/18/2023] Open
Abstract
This study analyzed the factors associated with tuberculosis in diabetics seen at health units of Vitória, ES, Brazil. This is a case-control study of 45 cases of diabetics seen in the 30 units of the municipality and reported in the SINAN with a diagnosis of tuberculosis in the 2007-2013 period and 90 cases of diabetic controls. We used data from the SINAN, the Health Information System of Vitória, and the Central Municipal Laboratory, as well a structured interview. Bivariate and multivariate analyses were performed, using logistic regression with the significant variables (p < 0.05). The case group presented a higher frequency of health-damaging life habits as compared to the control group, such as compulsive drinking (p < 0.001) and tobacco smoking (p = 0.060), as well as worse biochemical parameters, such as fasting blood sugar (p < 0.001) and glycosylated hemoglobin (p = 0.034). Regular drinking (OR 6.612, CI 2,151-20.330), previous contact with people with tuberculosis (OR 4.418, CI 1.678-11.631), and fasting blood sugar (OR 1.017, CI 1.007-1.026) were associated with tuberculosis in diabetics. The study reveals that poorer lifestyle habits and glycemic control and previous contact with active tuberculosis increase the chance of diabetics developing tuberculosis.
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Affiliation(s)
- Marcelle Lemos Leal
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29040-091 Vitória ES Brasil.
| | - Ethel Leonor Nóia Maciel
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29040-091 Vitória ES Brasil.
| | - Nágela Valadão Cade
- Programa de Pós-Graduação em Saúde Coletiva, Centro de Ciências da Saúde, Universidade Federal do Espírito Santo. Av. Marechal Campos 1468, Maruípe. 29040-091 Vitória ES Brasil.
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Pulmonary Tuberculosis Characteristics in a Patient with Type 2 Diabetes Mellitus. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2019. [DOI: 10.2478/rjdnmd-2019-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Tuberculosis (TB) and diabetes mellitus (DM) are two chronic diseases with major impact on worldwide morbidity and mortality. DM significantly increases the risk of death, therapeutic failure and relapse of TB, requiring a much more careful monitoring of these patients. In this article we present the case of a patient with type 2 DM in the stage of major chronic complications, with numerous risk factors for TB and atypical symptomatology, pulmonary X-ray showing active TB lesions. The patient did not follow the diabetologist's recommendations, discontinuing the antidiabetic treatment on his own initiative. The glycemic imbalance and chronic alcoholism caused the failure of the anti TB therapy.
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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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Prevalence of diabetes mellitus amongst hospitalized tuberculosis patients at an Indian tertiary care center: A descriptive analysis. PLoS One 2018; 13:e0200838. [PMID: 30021016 PMCID: PMC6051633 DOI: 10.1371/journal.pone.0200838] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/02/2018] [Indexed: 12/17/2022] Open
Abstract
Background India has a high prevalence of tuberculosis (TB) as well as diabetes mellitus (DM). DM is a chronic disease caused by deficiency of insulin production by the pancreas. The risk of TB amongst DM patients is three times higher than those without. The estimated national prevalence of DM is 7.3%. Despite the growing burden of DM, there are limited studies describing the prevalence of TB-DM in India. Objective Our study estimated the prevalence of DM amongst adult hospitalized TB patients at Kasturba Hospital, Manipal and determined factors associated with the likelihood of DM-TB co-prevalence. Methods We conducted a retrospective cohort study at Kasturba Hospital, Manipal Academy of Higher Education. All hospitalized adult patients diagnosed with pulmonary TB (PTB) and extrapulmonary TB (EPTB) between June 1st 2015 and June 30th 2016 were eligible for inclusion. Pediatric and pregnant TB patients were excluded from our study. Data were extracted from medical charts. Descriptive and multivariate analyses were performed in R. Multivariate analysis adjusted for age, gender, type of TB, history of TB, and nutrition (body mass index (BMI)) status. Results A total of 728 patients met the eligibility criteria, 517 (71%) were male, 210 (29%) female, 406 (56%) had PTB and 322 (44%) had EPTB. Amongst those with a nutritional status, 36 (30%) patients were underweight (BMI <18.4 kg/m2), 73 (40%) had a normal BMI (18.5kg/m2–24.9 kg/m2), 15 (8%) were overweight (BMI 25.0 kg/m2–29.9 kg/m2) and 9 (5%) were obese (BMI >30.0 kg/m2). A total of 720 (98.9%) of TB patients had at least one blood sugar test result. The overall prevalence of DM (n = 184) amongst TB patients was 25.3% (95% CI 22.2%, 28.6%). When stratified, it was 35.0% (30.4%, 39.9%) and 13.0% (9.7%, 17.3%) amongst PTB and EPTB patients respectively. TB patients aged 41–60 years had 3.51 times higher odds (aOR 3.51 (2.08, 6.07)) of having DM than patients 40 years or younger. Patients aged 60 years or older had 2.49 times higher odds (aOR 2.49 (1.28, 4.85)) of having DM than younger patients (<40 years). Females had lower odds (aOR 0.80 (0.46, 1.37)) of developing DM than male TB patients and patients with a history of TB had lower odds (aOR 0.73 (0.39, 1.32)) than newly diagnosed TB patients. Additionally, EPTB patients had significantly lower odds (aOR 0.26 (0.15, 0.43)) compared to PTB patients. Underweight patients also had significantly lower odds (aOR 0.25 (0.14, 0.42)) of having DM than normal weight patients. Conclusion Our study found a higher prevalence of TB-DM than the national average. TB-DM co-prevalence was significantly associated with age, type of TB and undernutrition. As India’s DM prevalence is expected to rise, TB-DM will become an increasingly important part of the TB epidemic requiring specialized study and care.
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Wagnew F, Eshetie S, Alebel A, Dessie G, Tesema C, Abajobir AA. Meta-analysis of the prevalence of tuberculosis in diabetic patients and its association with cigarette smoking in African and Asian countries. BMC Res Notes 2018; 11:298. [PMID: 29764477 PMCID: PMC5952828 DOI: 10.1186/s13104-018-3390-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 05/03/2018] [Indexed: 12/14/2022] Open
Abstract
Objective This systematic review and meta-analysis was undertaken to estimate the prevalence of tuberculosis in diabetic patients and to determine the effect of cigarette smoking. Results A total of 15 studies was included in the meta-analysis. The pooled overall prevalence of tuberculosis in diabetes was 4.72% (95% CI 3.62–5.83%). In sub-group analyses, the prevalence was 5.13% (95% CI 4.34–5.92%) in Africa, followed by 4.16% (95% CI 2.9–5.4%) in Asia. The odd ratio of tuberculosis among diabetes patients was 7.6 (95% CI 1.46–39) in cigarette smokers as compared to nonsmokers. Publication bias was detected based on graphic asymmetry of fun-nel plots, Begg’s and Egger’s tests (p < 0.05). Tuberculosis is a common co-morbidity in diabetic patients. Tuberculosis-diabetes co-morbidity is significantly higher in cigarette smokers. Electronic supplementary material The online version of this article (10.1186/s13104-018-3390-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fasil Wagnew
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
| | - Setegn Eshetie
- College of Health Science, University of Gondar, Gondar, Ethiopia
| | - Animut Alebel
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Getenet Dessie
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Cheru Tesema
- College of Health Science, Debre Markos University, Debre Markos, Ethiopia
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Berkowitz N, Okorie A, Goliath R, Levitt N, Wilkinson RJ, Oni T. The prevalence and determinants of active tuberculosis among diabetes patients in Cape Town, South Africa, a high HIV/TB burden setting. Diabetes Res Clin Pract 2018; 138:16-25. [PMID: 29382589 PMCID: PMC5931785 DOI: 10.1016/j.diabres.2018.01.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 12/23/2017] [Accepted: 01/23/2018] [Indexed: 11/19/2022]
Abstract
AIMS Studies addressing the association between diabetes mellitus (DM) and tuberculosis (TB) in sub-Saharan Africa are limited. We assessed the prevalence of active TB among DM patients at a primary care clinic, and identified risk factors for prevalent TB. METHODS A cross-sectional study was conducted in adult DM patients attending a clinic in Khayelitsha, Cape Town. Participants were screened for active TB (symptom screening and microbiological diagnosis) and HIV. RESULTS Among 440 DM patients screened, the active TB prevalence was 3.0% (95% CI 1.72-5.03). Of the 13 prevalent TB cases, 53.9% (n = 7; 95% CI 27.20-78.50) had no TB symptoms, and 61.5% (n = 8; 95% CI 33.30-83.70) were HIV-1 co-infected. There were no significant differences in either fasting plasma glucose or HbA1c levels between TB and non-TB participants. On multivariate analysis, HIV-1 infection (OR 11.3, 95% CI 3.26-39.42) and hemoptysis (OR 31.4, 95% CI 3.62-273.35) were strongly associated with prevalent active TB, with no differences in this association by age or gender. CONCLUSIONS The prevalence of active TB among DM patients was 4-fold higher than the national prevalence; suggesting the need for active TB screening, particularly if hemoptysis is reported. Our results highlight the importance of HIV screening in this older population group. The high prevalence of sub-clinical TB among those diagnosed with TB highlights the need for further research to determine how best to screen for active TB in high-risk TB/HIV population groups and settings.
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Affiliation(s)
- Natacha Berkowitz
- Clinical Infectious Disease Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Adaeze Okorie
- Division of Public Health Medicine, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Rene Goliath
- Clinical Infectious Disease Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Naomi Levitt
- Division of Diabetes and Endocrinology, Department of Medicine, Groote Schuur Hospital, Cape Town 7925, South Africa
| | - Robert J Wilkinson
- Clinical Infectious Disease Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; The Francis Crick Institute Mill Hill Laboratory, London NW7 1AA, United Kingdom
| | - Tolu Oni
- Clinical Infectious Disease Research Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town 7925, South Africa; Division of Public Health Medicine, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa.
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Shewade HD, Jeyashree K, Mahajan P, Shah AN, Kirubakaran R, Rao R, Kumar AMV. Effect of glycemic control and type of diabetes treatment on unsuccessful TB treatment outcomes among people with TB-Diabetes: A systematic review. PLoS One 2017; 12:e0186697. [PMID: 29059214 PMCID: PMC5653348 DOI: 10.1371/journal.pone.0186697] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 10/05/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Stringent glycemic control by using insulin as a replacement or in addition to oral hypoglycemic agents (OHAs) has been recommended for people with tuberculosis and diabetes mellitus (TB-DM). This systematic review (PROSPERO 2016:CRD42016039101) analyses whether this improves TB treatment outcomes. OBJECTIVES Among people with drug-susceptible TB and DM on anti-TB treatment, to determine the effect of i) glycemic control (stringent or less stringent) compared to poor glycemic control and ii) insulin (only or with OHAs) compared to 'OHAs only' on unsuccessful TB treatment outcome(s). We looked for unfavourable TB treatment outcomes at the end of intensive phase and/or end of TB treatment (minimum six months and maximum 12 months follow up). Secondary outcomes were development of MDR-TB during the course of treatment, recurrence after 6 months and/or after 1 year post successful treatment completion and development of adverse events related to glucose lowering treatment (including hypoglycemic episodes). METHODS All interventional studies (with comparison arm) and cohort studies on people with TB-DM on anti-TB treatment reporting glycemic control, DM treatment details and TB treatment outcomes were eligible. We searched electronic databases (EMBASE, PubMed, Google Scholar) and grey literature between 1996 and April 2017. Screening, data extraction and risk of bias assessment were done independently by two investigators and recourse to a third investigator, for resolution of differences. RESULTS After removal of duplicates from 2326 identified articles, 2054 underwent title and abstract screening. Following full text screening of 56 articles, nine cohort studies were included. Considering high methodological and clinical heterogeneity, we decided to report the results qualitatively and not perform a meta-analysis. Eight studies dealt with glycemic control, of which only two were free of the risk of bias (with confounder-adjusted measures of effect). An Indian study reported 30% fewer unsuccessful treatment outcomes (aOR (0.95 CI): 0.72 (0.64-0.81)) and 2.8 times higher odds of 'no recurrence' (aOR (0.95 CI): 2.83 (2.60-2.92)) among patients with optimal glycemic control at baseline. A Peruvian study reported faster culture conversion among those with glycemic control (aHR (0.95 CI): 2.2 (1.1,4)). Two poor quality studies reported the effect of insulin on TB treatment outcomes. CONCLUSION We identified few studies that were free of the risk of bias. There were limited data and inconsistent findings among available studies. We recommend robustly designed and analyzed studies including randomized controlled trials on the effect of glucose lowering treatment options on TB treatment outcomes.
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Affiliation(s)
- Hemant Deepak Shewade
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
| | | | - Preetam Mahajan
- All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India
| | - Amar N. Shah
- U.S. Agency for International Development (USAID), American Embassy, New Delhi, India
| | | | - Raghuram Rao
- Central TB Division, Revised National Tuberculosis Control Programme, Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Ajay M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France
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Workneh MH, Bjune GA, Yimer SA. Prevalence and associated factors of tuberculosis and diabetes mellitus comorbidity: A systematic review. PLoS One 2017; 12:e0175925. [PMID: 28430796 PMCID: PMC5400500 DOI: 10.1371/journal.pone.0175925] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/03/2017] [Indexed: 01/17/2023] Open
Abstract
Introduction The dual burden of tuberculosis (TB) and diabetes mellitus (DM) has become a major global public health concern. There is mounting evidence from different countries on the burden of TB and DM comorbidity. The objective of this systematic review was to summarize the existing evidence on prevalence and associated/risk factors of TBDM comorbidity at global and regional levels. Methods Ovid Medline, Embase, Global health, Cochrane library, Web of science and Scopus Elsevier databases were searched to identify eligible articles for the systematic review. Data were extracted using standardized excel form and pilot tested. Median with interquartile range (IQR) was used to estimate prevalence of TBDM comorbidity. Associated/risk factors that were identified from individual studies were thematically analyzed and described. Results The prevalence of DM among TB patients ranged from 1.9% to 45%. The overall median global prevalence was 16% (IQR 9.0%-25.3%) Similarly, the prevalence of TB among DM patients ranged from 0.38% to 14% and the overall median global prevalence was 4.1% (IQR 1.8%-6.2%). The highest prevalence of DM among TB patients is observed in the studied countries of Asia, North America and Oceania. On the contrary, the prevalence of TB among DM patients is low globally, but relatively higher in the studied countries of Asia and the African continents. Sex, older age, urban residence, tobacco smoking, sedentary lifestyle, poor glycemic control, having family history of DM and TB illness were among the variables identified as associated/risk factors for TBDM comorbidity. Conclusion This systematic review revealed that there is a high burden of DM among TB patients at global level. On the contrary, the global prevalence of TB among DM patients is low. Assessing the magnitude and risk/associated factors of TBDM comorbidity at country/local level is crucial before making decisions to undertake TBDM integrated services.
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Affiliation(s)
- Mahteme Haile Workneh
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
- * E-mail:
| | - Gunnar Aksel Bjune
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Solomon Abebe Yimer
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
- Amhara Regional State Health Bureau, Bahir-Dar, Ethiopia
- Department of Microbiology, Oslo University Hospital, Oslo, Norway
- Department of Bacteriology and Immunology, Norwegian Institute of Public Health, Oslo, Norway
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Firănescu AG, Popa A, Roşu MM, Protasiewicz DC, Popa SG, Ioana M, Moța M. The Diabetes-Tuberculosis Co-Epidemic: The Interaction between Individual and Socio-Economic Risk Factors. ROMANIAN JOURNAL OF DIABETES NUTRITION AND METABOLIC DISEASES 2017. [DOI: 10.1515/rjdnmd-2017-0009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Worldwide, tuberculosis (TB) is a major cause of morbi-mortality, about 30% of the population having a Mycobacterium tuberculosis infection. Patients with diabetes mellitus (DM) have a threefold increased risk of developing the disease. The prevalence of DM is rapidly increasing, especially in countries with low and middle income, where TB incidence is also increased, thus baffling the efforts for TB control. The DM-TB co-epidemic is more frequent in married, older men, with reduced level of education, low income, without a steady job, with lifestyle habits such as alcohol consumption, smoking, sedentarism, living in an urban environment, in crowded areas, in insanitary conditions. These patients have a higher body mass index (BMI) compared with those without DM and frequently present family history of TB, family history of DM, longer duration of DM and reduced glycemic control. TB associated with DM is usually asymptomatic, more contagious, multidrug resistant and is significantly associated with an increased risk of therapy failure, relapse and even death. Thus, the DM-TB comorbidity represents a threat to public health and requires the implementation of urgent measures in order to both prevent and manage the two diseases.
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Affiliation(s)
- Adela-Gabriela Firănescu
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical County Emergency Hospital, Craiova, Romania
- University of Medicine and Pharmacy, Craiova, Romania
| | - Adina Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical County Emergency Hospital, Craiova, Romania
| | - Maria-Magdalena Roşu
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical County Emergency Hospital, Craiova, Romania
- University of Medicine and Pharmacy, Craiova, Romania
| | - Diana Cristina Protasiewicz
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical County Emergency Hospital, Craiova, Romania
- University of Medicine and Pharmacy, Craiova, Romania
| | - Simona Georgiana Popa
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical County Emergency Hospital, Craiova, Romania
- University of Medicine and Pharmacy, Craiova, Romania
| | - Mihai Ioana
- University of Medicine and Pharmacy, Craiova, Romania
| | - Maria Moța
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical County Emergency Hospital, Craiova, Romania
- University of Medicine and Pharmacy, Craiova, Romania
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Harries AD, Kumar AMV, Satyanarayana S, Lin Y, Zachariah R, Lönnroth K, Kapur A. Addressing diabetes mellitus as part of the strategy for ending TB. Trans R Soc Trop Med Hyg 2016; 110:173-9. [PMID: 26884497 PMCID: PMC4755424 DOI: 10.1093/trstmh/trv111] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
As we enter the new era of Sustainable Development Goals, the international community has committed to ending the TB epidemic by 2030 through implementation of an ambitious strategy to reduce TB-incidence and TB-related mortality and avoiding catastrophic costs for TB-affected families. Diabetes mellitus (DM) triples the risk of TB and increases the probability of adverse TB treatment outcomes such as failure, death and recurrent TB. The rapidly escalating global epidemic of DM means that DM needs to be addressed if TB-related milestones and targets are to be achieved. WHO and the International Union Against Tuberculosis and Lung Disease's Collaborative Framework for Care and Control of Tuberculosis and Diabetes, launched in 2011, provides a template to guide policy makers and implementers to combat the epidemics of both diseases. However, more evidence is required to answer important questions about bi-directional screening, optimal ways of delivering treatment, integration of DM and TB services, and infection control. This should in turn contribute to better and earlier TB case detection, and improved TB treatment outcomes and prevention. DM and TB collaborative care can also help guide the development of a more effective and integrated public health approach for managing non-communicable diseases.
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Affiliation(s)
- Anthony D Harries
- International Union Against Tuberculosis and Lung Disease, Paris, France London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | - Yan Lin
- China Office, International Union Against Tuberculosis and Lung Disease, Beijing, China
| | - Rony Zachariah
- Médecins sans Frontières, Medical Department, Operational Research Unit, Brussels Operational Center, Luxembourg City, Luxembourg
| | - Knut Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark
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Dos Santos Feltrin AF, Vendramini SHF, Neto FC, de Vechi Correa AP, Werneck AL, Dos Santos Sasaki NSGM, de Lourdes Sperli Geraldes Santos M. Death in patients with tuberculosis and diabetes: Associated factors. Diabetes Res Clin Pract 2016; 120:111-6. [PMID: 27525367 DOI: 10.1016/j.diabres.2016.07.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/19/2016] [Accepted: 07/30/2016] [Indexed: 10/21/2022]
Abstract
AIMS Identify factors associated with death in patients with tuberculosis and diabetes. METHOD The descriptive - analytic epidemiologic study using secondary data of tuberculosis cases reported in TBWEB from 1996 to 2014 is used. The profile analysis of the variables in relation to death controlled by the cure of the patients was performed by the software R, the independent variables that could be associated with the dependent variable in a 20% significance level, using the chi-square test. The analysis was performed on an unconditional logistic regression model. Odds ratio (OR) adjusted measures were obtained in order to evaluate the strength of association between independent variables. RESULTS Looking into the database TBWEB, from 1996 to 2014, 5361 cases of TB were reported, and from these cases, 4447 contained information about the closure and were complete. Patients with TB and DM represented 306 cases (6.35%). In relation to death, protective factors were: diabetes with OR: 0.69; follow up received during the treatment of medium and high complexity services, with OR: 0.51 and the other type with OR: 0.56. CONCLUSION Diabetes appeared as a protective factor for death in patients with tuberculosis in this study. The development of studies like this allows the expansion of knowledge on the TB-DM association.
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Affiliation(s)
- Aline Fiori Dos Santos Feltrin
- Programa de Pós-Graduação Stricto Sensu em Enfermagem, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.
| | | | | | | | - Alexandre Lins Werneck
- Departamento de Medicina, Faculdade de Medicina de São José do Rio Preto, São José do Rio Preto, São Paulo, Brazil.
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Harries AD, Kumar AMV, Satyanarayana S, Lin Y, Zachariah R, Lönnroth K, Kapur A. Diabetes mellitus and tuberculosis: programmatic management issues. Int J Tuberc Lung Dis 2016; 19:879-86. [PMID: 26162352 PMCID: PMC4497633 DOI: 10.5588/ijtld.15.0069] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
In August 2011, the World Health Organization and the International Union Against Tuberculosis and Lung Disease launched the Collaborative Framework for Care and Control of Tuberculosis (TB) and diabetes mellitus (DM) to guide policy makers and implementers in combatting the epidemics of both diseases. Progress has been made, and includes identifying how best to undertake bidirectional screening for both diseases, how to provide optimal treatment and care for patients with dual disease and the most suitable framework for monitoring and evaluation. Key programmatic challenges include the following: whether screening should be directed at all patients or targeted at those with high-risk characteristics; the most suitable technologies for diagnosing TB and diabetes in routine settings; the best time to screen TB patients for DM; how to provide an integrated, coordinated approach to case management; and finally, how to persuade non-communicable disease programmes to adopt a cohort analysis approach, preferably using electronic medical records, for monitoring and evaluation. The link between DM and TB and the implementation of the collaborative framework for care and control have the potential to stimulate and strengthen the scale-up of non-communicable disease care and prevention programmes, which may help in reducing not only the global burden of DM but also the global burden of TB.
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Affiliation(s)
- A D Harries
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France; London School of Hygiene & Tropical Medicine, London, UK
| | - A M V Kumar
- The Union South-East Asia Regional Office, New Delhi, India
| | | | - Y Lin
- The Union China Office, Beijing, China
| | - R Zachariah
- Medical Department, Operational Research Unit, Médecins Sans Frontières, Brussels Operational Centre, Luxembourg, Luxembourg
| | - K Lönnroth
- Global TB Programme, World Health Organization, Geneva, Switzerland, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - A Kapur
- World Diabetes Foundation, Gentofte, Denmark
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Satyanarayana S, Kumar AMV, Wilson N, Kapur A, Harries AD, Zachariah R. Taking on the diabetes-tuberculosis epidemic in India: paving the way through operational research. Public Health Action 2015; 3:S1-2. [PMID: 26393061 DOI: 10.5588/pha.13.0039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Srinath Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Ajay M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Nevin Wilson
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India
| | - Anil Kapur
- World Diabetes Foundation, Gentofte, Denmark
| | - Anthony D Harries
- The Union, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK
| | - Rony Zachariah
- Médecins Sans Frontières, Medical Department, Operational Research Unit, Brussels Operational Center, Luxembourg, Luxembourg
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Kumar AMV, Satyanarayana S, Berger SD, Chadha SS, Singh RJ, Lal P, Tonsing J, Harries AD. Promoting operational research through fellowships: a case study from the South-East Asia Union Office. Public Health Action 2015; 5:6-16. [PMID: 26400596 PMCID: PMC4525361 DOI: 10.5588/pha.14.0111] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/27/2015] [Indexed: 11/10/2022] Open
Abstract
In 2009, the International Union Against Tuberculosis and Lung Disease (The Union) and Médecins Sans Frontières (MSF) jointly developed a new paradigm for operational research (OR) capacity building and started a new process of appointing and supporting OR fellows in the field. This case study describes 1) the appointment of two OR fellows in The Union South-East Asia Office (USEA), New Delhi, India; 2) how this led to the development of an OR unit in that organisation; 3) achievements over the 5-year period from June 2009 to June 2014; and 4) challenges and lessons learnt. In June 2009, the first OR fellow in India was appointed on a full-time basis and the second was appointed in February 2012-both had limited previous experience in OR. From 2009 to 2014, annual research output and capacity building initiatives rose exponentially, and included 1) facilitation at 61 OR training courses/modules; 2) publication of 96 papers, several of which had a lasting impact on national policy and practice; 3) providing technical assistance in promoting OR; 4) building the capacity of medical college professionals in data management; 5) support to programme staff for disseminating their research findings; 6) reviewing 28 scientific papers for national or international peer-reviewed journals; and 7) developing 45 scientific abstracts for presentation at national and international conferences. The reasons for this success are highlighted along with ongoing challenges. This experience from India provides good evidence for promoting similar models elsewhere.
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Affiliation(s)
- A. M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - S. Satyanarayana
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | | | - S. S. Chadha
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - R. J. Singh
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - P. Lal
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - J. Tonsing
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Regional Office, New Delhi, India
| | - A. D. Harries
- The Union, Paris, France
- London School of Hygiene & Tropical Medicine, London, UK
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Lin YH, Chen CP, Chen PY, Huang JC, Ho C, Weng HH, Tsai YH, Peng YS. Screening for pulmonary tuberculosis in type 2 diabetes elderly: a cross-sectional study in a community hospital. BMC Public Health 2015; 15:3. [PMID: 25572102 PMCID: PMC4324855 DOI: 10.1186/1471-2458-15-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 12/09/2014] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Tuberculosis is one of the major infectious diseases in Taiwan. It has an especially high prevalence in diabetes patients, in whom it is usually asymptomatic and are more likely to result in drug-resistant tuberculosis. The aim of the study was to aggressively screen high risk diabetic elderly, identify the prevalence of tuberculosis and its determinants. METHODS Type 2 diabetes patients aged over 65 years were enrolled. They received chest X-rays, blood tests and the questionnaires to assess their medical history and symptoms. Suspicious cases were referred to the pulmonary or infectious disease outpatient clinics. Pulmonary tuberculosis was confirmed by sputum culture. Variables between groups were analyzed by Student t test, Chi-square test or Fisher's exact test. Risk factors were assessed using univariate logistic regression and multiple logistic regression. RESULTS A total of 3,087 patients participated this screening program and 7 patients screened positive for pulmonary tuberculosis. Another 5 patients were being under treatment when participating screening program. The prevalence rate was 3.89 per thousand people. The patients with male gender, smoking, liver cirrhosis or subjective body weight loss were associated with an increased risk of tuberculosis significantly. Subjective body weight loss (OR: 6.635 [95% CI: 2.096-21.007]), liver cirrhosis (OR: 10.307 [95% CI: 2.108-50.395]) and history of smoking (OR: 3.981 [95% CI: 1.246-12.718]) are independent risk factors. Among all 73 patients with active tuberculosis or tuberculosis history, they tended to be male, lower body mass index (BMI), more smoking history, more alcohol consumption, more family history of tuberculosis, higher low density lipoprotein (LDL), and less hypertension. However, there was no significant difference in the glycated hemoglobin (HbA1c) levels between the tuberculosis group and non-tuberculosis group. CONCLUSIONS Active screening program is helpful in detecting pulmonary tuberculosis in elderly diabetes patients. Subjective body weight loss, smoking and liver cirrhosis are independent risk factors.
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Affiliation(s)
- Yung-Hsiang Lin
- />Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd, Puzih City, Chiayi County 613 Taiwan
| | - Chia-Pei Chen
- />Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd, Puzih City, Chiayi County 613 Taiwan
| | - Pao-Ying Chen
- />Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd, Puzih City, Chiayi County 613 Taiwan
| | - Jui-Chu Huang
- />Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd, Puzih City, Chiayi County 613 Taiwan
| | - Cheng Ho
- />Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd, Puzih City, Chiayi County 613 Taiwan
| | - Hsu-Huei Weng
- />Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Chiayi, Taiwan
- />Chang Gung University, College of Medicine, Tao-Yuan, Taiwan
| | - Ying-Huang Tsai
- />Division of Thoracic and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- />Chang Gung University, College of Medicine, Tao-Yuan, Taiwan
| | - Yun-Shing Peng
- />Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, No.6, W. Sec., Jiapu Rd, Puzih City, Chiayi County 613 Taiwan
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Castellanos-Joya M, Delgado-Sánchez G, Ferreyra-Reyes L, Cruz-Hervert P, Ferreira-Guerrero E, Ortiz-Solís G, Jiménez MI, Salazar LL, Montero-Campos R, Mongua-Rodríguez N, Baez-Saldaña R, Bobadilla-del-Valle M, González-Roldán JF, Ponce-de-León A, Sifuentes-Osornio J, García-García L. Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico. PLoS One 2014; 9:e106961. [PMID: 25229236 PMCID: PMC4167852 DOI: 10.1371/journal.pone.0106961] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 08/03/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Recently, the World Health Organisation and the International Union Against Tuberculosis and Lung Disease published a Collaborative Framework for the Care and Control of Tuberculosis (TB) and Diabetes (DM) (CFTB/DM) proposing bidirectional screening and joint management. OBJECTIVE To evaluate the feasibility and effectiveness of the CFTB/DM in Mexico. DESIGN Prospective observational cohort. SETTING 15 primary care units in 5 states in Mexico. PARTICIPANTS Patients aged ≥20 years diagnosed with DM or pulmonary TB who sought care at participating clinics. INTERVENTION The WHO/Union CFTB/DM was adapted and implemented according to official Mexican guidelines. We recruited participants from July 2012 to April 2013 and followed up until March 2014. Bidirectional screening was performed. Patients diagnosed with TB and DM were invited to receive TB treatment under joint management. MAIN OUTCOME MEASURES Diagnoses of TB among DM, of DM among TB, and treatment outcomes among patients with DM and TB. RESULTS Of 783 DM patients, 11 (1.4%) were unaware of their TB. Of 361 TB patients, 16 (4.4%) were unaware of their DM. 95 TB/DM patients accepted to be treated under joint management, of whom 85 (89.5%) successfully completed treatment. Multiple linear regression analysis with change in HbA1c and random capillary glucose as dependent variables revealed significant decrease with time (regression coefficients (β) = -0.660, (95% confidence interval (CI), -0.96 to -0.35); and β = -1.889 (95% CI, -2.77 to -1.01, respectively)) adjusting by sex, age and having been treated for a previous TB episode. Patients treated under joint management were more likely to experience treatment success than patients treated under routine DM and TB programs as compared to historical (adjusted OR (aOR), 2.8, 95%CI 1.28-6.13) and same period (aOR 2.37, 95% CI 1.13-4.96) comparison groups. CONCLUSIONS Joint management of TB and DM is feasible and appears to improve clinical outcomes.
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Affiliation(s)
- Martín Castellanos-Joya
- Dirección del Programa de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Guadalupe Delgado-Sánchez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Leticia Ferreyra-Reyes
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Pablo Cruz-Hervert
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Elizabeth Ferreira-Guerrero
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Gabriela Ortiz-Solís
- Dirección del Programa de Salud en el Adulto y en el Anciano, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Mirtha Irene Jiménez
- Dirección del Programa de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Leslie Lorena Salazar
- Dirección del Programa de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Rogelio Montero-Campos
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Norma Mongua-Rodríguez
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Renata Baez-Saldaña
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
| | - Miriam Bobadilla-del-Valle
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Jesús Felipe González-Roldán
- Dirección General, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México
| | - Alfredo Ponce-de-León
- Laboratorio de Microbiología, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - José Sifuentes-Osornio
- Dirección Médica, Instituto Nacional de Ciencias Médicas y de Nutrición “Salvador Zubirán”, México, Distrito Federal, México
| | - Lourdes García-García
- Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- * E-mail:
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Lönnroth K, Roglic G, Harries AD. Improving tuberculosis prevention and care through addressing the global diabetes epidemic: from evidence to policy and practice. Lancet Diabetes Endocrinol 2014; 2:730-9. [PMID: 25194886 DOI: 10.1016/s2213-8587(14)70109-3] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diabetes triples the risk of tuberculosis and is also a risk factor for adverse tuberculosis treatment outcomes, including death. Prevalence of diabetes is increasing globally, but most rapidly in low-income and middle-income countries where tuberculosis is a grave public health problem. Growth in this double disease burden creates additional obstacles for tuberculosis care and prevention. We review how the evolution of evidence on the link between tuberculosis and diabetes has informed global policy on collaborative activities, and how practice is starting to change as a consequence. We conclude that coordinated planning and service delivery across communicable and non-communicable disease programmes is necessary, feasible, and creates synergies that will help to reduce the burden of both tuberculosis and diabetes.
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Affiliation(s)
- Knut Lönnroth
- Departments of Global TB Programme, World Health Organization, Geneva, Switzerland.
| | - Gojka Roglic
- Management of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
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Riza AL, Pearson F, Ugarte-Gil C, Alisjahbana B, van de Vijver S, Panduru NM, Hill PC, Ruslami R, Moore D, Aarnoutse R, Critchley JA, van Crevel R. Clinical management of concurrent diabetes and tuberculosis and the implications for patient services. Lancet Diabetes Endocrinol 2014; 2:740-53. [PMID: 25194887 PMCID: PMC4852378 DOI: 10.1016/s2213-8587(14)70110-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Diabetes triples the risk for active tuberculosis, thus the increasing burden of type 2 diabetes will help to sustain the present tuberculosis epidemic. Recommendations have been made for bidirectional screening, but evidence is scarce about the performance of specific tuberculosis tests in individuals with diabetes, specific diabetes tests in patients with tuberculosis, and screening and preventive therapy for latent tuberculosis infections in individuals with diabetes. Clinical management of patients with both diseases can be difficult. Tuberculosis patients with diabetes have a lower concentration of tuberculosis drugs and a higher risk of drug toxicity than tuberculosis patients without diabetes. Good glycaemic control, which reduces long-term diabetes complications and could also improve tuberculosis treatment outcomes, is hampered by chronic inflammation, drug-drug interactions, suboptimum adherence to drug treatments, and other factors. Besides drug treatments for tuberculosis and diabetes, other interventions, such as education, intensive monitoring, and lifestyle interventions, might be needed, especially for patients with newly diagnosed diabetes or those who need insulin. From a health systems point of view, delivery of optimum care and integration of services for tuberculosis and diabetes is a huge challenge in many countries. Experience from the combined tuberculosis and HIV/AIDS epidemic could serve as an example, but more studies are needed that include economic assessments of recommended screening and systems to manage concurrent tuberculosis and diabetes.
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Affiliation(s)
- Anca Lelia Riza
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands; Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Fiona Pearson
- Population Health Research Institute, St Georges University, London, UK
| | - Cesar Ugarte-Gil
- Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bachti Alisjahbana
- Center for TB-HIV research, Medical Faculty, Padjadjaran University, Hasan Sadikin Hosptial, Bandung, Indonesia
| | - Steven van de Vijver
- African Population and Health Research Center, Nairobi, Kenya; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands
| | - Nicolae M Panduru
- Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania; 2nd Clinical Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Philip C Hill
- Centre for International Health, Faculty of Medicine, Otago University, Dunedin, New Zealand
| | - Rovina Ruslami
- Department of Pharmacology and Therapy, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia
| | - David Moore
- London School of Hygiene and Tropical Medicine, London, UK
| | - Rob Aarnoutse
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands
| | - Julia A Critchley
- Population Health Research Institute, St Georges University, London, UK
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands.
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