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Kibirige D, Andia-Biraro I, Olum R, Adakun S, Zawedde-Muyanja S, Sekaggya-Wiltshire C, Kimuli I. Tuberculosis and diabetes mellitus comorbidity in an adult Ugandan population. BMC Infect Dis 2024; 24:242. [PMID: 38389045 PMCID: PMC10885501 DOI: 10.1186/s12879-024-09111-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) has a direct impact on the clinical manifestation and prognosis of active tuberculosis disease (TB) and is known to increase the chance of developing the condition. We sought to determine the prevalence of DM in adult Ugandan patients with recently diagnosed TB and the associated sociodemographic, anthropometric, and metabolic characteristics of TB-DM comorbidity. METHODS In this cross-sectional study conducted at the adult TB treatment centres of three tertiary healthcare facilities in Uganda, we screened adult participants with recently diagnosed TB (diagnosed in < 2 months) for DM. All participants were screened with five tests; initially with a random blood glucose (RBG) test, and then later with fasting blood glucose (FBG), laboratory-based glycated hemoglobin (HbA1c), point-of-care (POC) HbA1c, and oral glucose tolerance test (OGTT) if the RBG was ≥ 6.1 mmol/l. The WHO guidelines for diagnosing and managing DM were used to support the DM diagnosis. To identify the factors associated with DM-TB comorbidity, logistic regression was used. RESULTS A total of 232 participants with recently diagnosed TB were screened for DM. Of these, 160 (69%) were female. The median (IQR) age, body mass index, and RBG of all study participants was 35 (27-42) years, 19.2 (17.6-21.3) kg/m2, and 6.1 (5.5-7.2) mmol/l, respectively. About half of the participants (n = 117, 50.4%) had RBG level ≥ 6.1 mmol/l. Of these, 75 (64.1%) participants returned for re-testing. Diabetes mellitus was diagnosed in 32 participants, corresponding to a prevalence of 13.8% (95% CI 9.9-18.9). A new diagnosis of DM was noted in 29 (90.6%) participants. On logistic regression, age ≥ 40 years was associated with increased odds of TB and DM comorbidity (AOR 3.12, 95% CI 1.35-7.23, p = 0.008) while HIV coinfection was protective (AOR 0.27, 95% CI 0.10-0.74, p = 0.01). CONCLUSION TB and DM comorbidity was relatively common in this study population. Routine screening for DM in adult Ugandan patients with recently diagnosed TB especially among those aged ≥ 40 years and HIV-negative patients should be encouraged in clinical practice.
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Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda.
- Non-communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
| | - Irene Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- Makerere University School of Public Health, Kampala, Uganda
| | - Susan Adakun
- Adult Tuberculosis ward, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | | | - Ivan Kimuli
- Department of Physiology, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
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Gourlay A, Sutherland C, Radley A. Point-of-Care testing of HbA 1c levels in community settings for people with established diabetes or people at risk of developing diabetes: A systematic review and meta-analysis. Prim Care Diabetes 2024; 18:7-16. [PMID: 37925311 DOI: 10.1016/j.pcd.2023.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/19/2023] [Accepted: 10/22/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Glycated haemoglobin (HbA1c) measurement using Point of Care (POC) testing may be of huge utility, providing convenient testing for early diagnosis and regular monitoring of hard-to-reach patient groups. This systematic review aimed to identify evidence for the successful deployment of these devices to improve patient outcomes in diabetes. METHODS A systematic review and meta-analysis was undertaken in February 2023, to identify all relevant articles: (CINAHL, Cochrane, PubMed, Scopus, and Web of Science). Studies were included if they reported outcomes of community POC testing for HbA1c for people with diabetes or at risk of diabetes. The Prospero database and trial registers were searched. Only English language articles were included. Title, abstract screening and full text review was carried out by two reviewers (AG/AR). The Cochrane risk of bias tool for randomised studies and the NIH Quality Assessment tool for observational cohort and cross-sectional studies were used. Publication bias was assessed visually using funnel plot and statistical assessment. We performed a meta-analysis on appropriate studies, applying a fixed effect model. We investigated heterogeneity using visual inspection of forest plots along with evaluative approaches (χ2, I2). Strength of evidence was assessed using GRADE. FINDINGS 24 studies fulfilled the criteria to be included in the narrative synthesis and 5 could be included in quantitative analysis. 13 studies evaluated HbA1c POC testing in non-diabetic patients, 9 reported results for diabetic patients and 2 included both groups. The narrative synthesis was constructed around 6 key themes: increased test access, diagnosis of people who would otherwise go undiagnosed, intervention/lifestyle change, POC testing effect on HbA1c and glycaemic control, follow-up time and patient satisfaction. INTERPRETATION The available published data supports the proposed use of POC devices in a community setting, with positive effects on diabetic care with limited evidence that patients can achieve better glycaemic control.
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Affiliation(s)
- Anna Gourlay
- School of Life Sciences, University of Dundee, Scotland
| | | | - Andrew Radley
- School of Medicine, University of Dundee, Scotland; Directorate of Public Health, NHS Tayside, UK.
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Kakisingi C, Mwamba C, Kasongo Muteba M, Kasamba E, Kabamba M, Tanon A, Situakibanza H. Prevalence and Associated Factors of Diabetes Mellitus Among Newly Enrolled Tuberculosis Patients in Lubumbashi (DRC). Risk Manag Healthc Policy 2024; 17:171-180. [PMID: 38250217 PMCID: PMC10800086 DOI: 10.2147/rmhp.s436873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/10/2024] [Indexed: 01/23/2024] Open
Abstract
Background Tuberculosis and diabetes mellitus are major public health challenges worldwide. The two scourges have bidirectional relationship with high morbidity and mortality. Objective The present study was conducted to determine the prevalence of diabetes mellitus and identify related factors in patients with tuberculosis. Methods A cross-sectional study was conducted in 11 tuberculosis screening and treatment centers in Lubumbashi (DRC) from September to December 2022. Adult patient with a positive smear for tuberculosis were systematically screened for diabetes mellitus. Demographic characteristics, history and symptomatology were the variables of interest. Data was entered using Microsoft Excel software. STATA 16 software was used for analysis. Results A total of 255 tuberculosis patients were recruited and the prevalence of diabetes mellitus among these patients was 11.4% (ie, 29 out of 255). After uni and multivariate logistic regression, a BMI ≤ 18.5 Kg/m2, lack of employment, polyuria and intense thirst were the factors associated with diabetes mellitus in tuberculosis patients. Conclusion The prevalence of diabetes mellitus in smear positive tuberculosis patients in the present study was higher than the one observed in Central Africa.
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Affiliation(s)
- Christian Kakisingi
- Internal Medicine Department, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Claude Mwamba
- Internal Medicine Department, University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Michel Kasongo Muteba
- Division of Epidemiology and Biostatistics, University ofWitwatersrand, Johannesburg, Republic of South Africa
| | - Eric Kasamba
- Department of Basics Sciences. University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Michel Kabamba
- Public Health Department, University of Kamina, Kamina, Democratic Republic of the Congo
| | - Aristophane Tanon
- Specialities and Medicine Department, University of Félix Houphouët-Boigny of Abidjan Cocody, Abidjan, Ivory Coast
| | - Hippolyte Situakibanza
- Internal Medicine Department, Tropical Diseases, Infectious and Parasitic Department, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
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Radley A, Beer L, Rushdi D, Close H, McBurney S, Mackenzie A, Gourlay A, Barnett A, Grant A, Greig N, Dow E, Sutherland C. Implementation of point-of-care HbA1C instruments into community pharmacies: Initial development of a pathway for robust community testing. Ann Clin Biochem 2023:45632231219380. [PMID: 37996254 DOI: 10.1177/00045632231219380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND Point-of-care (POC) analysers in community settings can provide opportunistic and regular HbA1c monitoring. Community pharmacies in NHS Scotland are utilised by populations at greatest risk of type two diabetes (T2D). This study describes initial development of an HbA1c pathway using a POC analyser in community pharmacies. METHODS The Abbott Afinion analyser was compared in (i) NHS Tayside's Blood Sciences Service and (ii) community pharmacies from four Scottish Health Boards. A side by side comparison with standard operating procedures for HbA1c quantification using 80 T2D patient venous samples. The machine was implemented into 11 community pharmacies and 144 samples obtained from patients for comparison to their recent laboratory HbA1c. Four focus groups examined themes around the intervention and an exit questionnaire was administered. RESULTS Laboratory assessment verified the efficacy of the POC test machine. The value for level 1 quality control was 44 mmol/mol and the mean during testing 42.7 mmol/mol. The greatest percent coefficient of variation (cv) was within-run for both levels of quality control material, at a value of 1.63% and 1.62%, respectively. The analyser performed robustly within the pharmacy assessment, with a mean difference of 1.68 and a standard deviation of 0.71 (CV 0.423). Patients with T2D reported positive experiences of using a pharmacy. The focus groups identified an appreciation of the convenience of pharmacies and of the longitudinal relationships with pharmacy staff. CONCLUSION POC HbA1c analysers can be successfully established in community pharmacies. The target patient group responded positively to the opportunity to use a pharmacy service.
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Affiliation(s)
- Andrew Radley
- School of Medicine, University of Dundee, Dundee, UK
| | | | | | | | | | | | - Anna Gourlay
- School of Medicine, University of Dundee, Dundee, UK
| | - Anna Barnett
- NHS Research Scotland, Diabetes Network and School of Medicine, University of Dundee, Dundee, UK
| | | | | | - Ellie Dow
- Blood Sciences, NHS Tayside, Dundee, UK
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Kerama C, Horne D, Ong’ang’o J, Anzala O. Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2023; 47:53. [PMID: 37073382 PMCID: PMC10098226 DOI: 10.1186/s42269-023-01029-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/09/2023] [Indexed: 05/03/2023]
Abstract
Background The END TB 2035 goal has a long way to go in low-income and low/middle-income countries (LICs and LMICs) from the perspective of a non-communicable disease (NCD) control interaction with tuberculosis (TB). The World Health Organization has identified diabetes as a determinant for, and an important yet neglected risk factor for tuberculosis. National guidelines have dictated testing time points, but these tend to be at an isolated time point rather than over a period of time. This article aims to give perspective on the syndemic interaction of tuberculosis and dysglycaemia and how the gaps in addressing the two may hamper progress towards END TB 2035. Main text Glycated haemoglobin (HbA1C) has a strong predictive association with the progression to subsequent diabetes. Therefore, screening using this measure could be a good way to screen at TB initiation therapy, in lieu of using the random blood sugar or fasting plasma glucose only. HbA1C has an observed gradient with mortality risk making it an informative predictor of outcomes. Determining the progression of dysglycaemia from diagnosis to end of treatment and shortly after may offer information on the best time point to screen and follow-up. Despite TB and Human Immunodeficiency Virus (HIV) disease care being free, hidden costs remain. These costs are additive if there is accompanying dysglycaemia. Regardless of receiving TB treatment, it is estimated that almost half of persons affected by pulmonary TB develop post-TB lung disease (PTLD) as an outcome and the contribution of dysglycaemia is not well described. Conclusions Establishing costs of treating TB with diabetes/prediabetes alone and in the additional context of HIV co-infection will inform policy makers on what it takes, financially, to treat these patients and subsidize dysglycaemia care. In Kenya, cardiovascular disease is only rivalled by infectious disease as a cause of mortality, and diabetes is a well-described risk factor for cardiac disease. In poor countries, communicable diseases are responsible for majority of the mortality burden, but societal shifts and rural-urban migration may have contributed to the observed increase of NCDs.
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Affiliation(s)
- Cheryl Kerama
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute (CRDR-KEMRI), Past Government Chemist, Opposite Diabetes Clinic, Nairobi, Kenya
- Division of Medical Microbiology and Immunology, Kenya AIDS Vaccine Initiative-Institute for Clinical Research (KAVI-ICR), Nairobi, Kenya
| | - David Horne
- Division of Pulmonary and Critical Care and Sleep Medicine, University of Washington, Seattle, WA USA
| | - Jane Ong’ang’o
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute (CRDR-KEMRI), Past Government Chemist, Opposite Diabetes Clinic, Nairobi, Kenya
| | - Omu Anzala
- Division of Medical Microbiology and Immunology, Kenya AIDS Vaccine Initiative-Institute for Clinical Research (KAVI-ICR), Nairobi, Kenya
- School of Medicine, Faculty of Health Sciences, University of Nairobi, Nairobi, Kenya
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Luiz Bezerra1 A, da Silva Rezende Moreira1 A, Isidoro-Gonçalves2 L, F. dos Santos Lara1,3 C, Amorim4 G, C. Silva1,5,6,7 E, Lineu Kritski1 A, Cristina C. Carvalho1,2 A. Clinical, laboratory, and radiographic aspects of patients with pulmonary tuberculosis and dysglycemia and tuberculosis treatment outcomes. J Bras Pneumol 2022; 48:e20210505. [DOI: 10.36416/1806-3756/e20210505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/19/2022] [Indexed: 11/09/2022] Open
Abstract
Objective: To analyze the association of dysglycemia with clinical, laboratory, and radiographic characteristics of patients with pulmonary tuberculosis (PTB), as well as with their tuberculo-sis treatment outcomes. Methods: This was a longitudinal study involving 140 patients diag-nosed with PTB (positive cultures for Mycobacterium tuberculosis or positive Xpert MTB/RIF results from sputum samples). Patients were evaluated at diagnosis (M0), after completing the second month of treatment (M2), and at the end of treatment (MEND). At M0, the pati-ents were classified into three groups: normoglycemia+PTB (NGTB); pre-diabetes melli-tus+PTB (PDMTB), and diabetes mellitus+PTB (DMTB), in accordance with glycated hemoglo-bin levels (< 5.7%, 5.7%-6.4%, and = 6.5%, respectively). Treatment outcomes were classified as favorable (cure or treatment completion) and unfavorable (death, loss to follow-up, or treatment failure). Results: In our sample, 76 patients (61.4%) had dysglycemia, 20 of whom (14.3%) had DM at M0. The patients with dysglycemia, in comparison with those in the NGTB group, more frequently presented with positive sputum smear microscopy (94.2% vs. 75.9%; p = 0.003); cavities (80.2% vs. 63.0%; p = 0.03); bilateral lesions (67.4% vs. 46.0%; p = 0.02); and higher median of affected thirds of the lungs (3.0 vs. 2.0; p = 0.03) on chest radiography. No significant differences regarding outcomes were found among the groups, but tuberculosis lethality was higher in the DMTB group than in the PDMTB and NGTB groups (20% vs. 2.2%). Conclusions: PTB patients with dysglycemia had laboratory and radiographic manifestations indicative of more advanced disease, and the risk of death was higher in the DMTB group. These findings reinforce the recommendation for early screening for DM in patients with newly diagnosed tuberculosis in order to reduce the risk of death during treatment.
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Affiliation(s)
- André Luiz Bezerra1
- 1. Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Lorrayne Isidoro-Gonçalves2
- 2. Laboratório de Inovações em Terapias, Ensino e Bioprodutos – LITEB – Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro (RJ) Brasil
| | - Carla F. dos Santos Lara1,3
- 1. Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil. 3. Serviço de Tisiologia, Centro Municipal de Saúde de Duque de Caxias, Secretaria Municipal de Duque de Caxias, Duque de Caxias (RJ) Brasil
| | - Gustavo Amorim4
- 4. Department of Biostatistics, Vanderbilt University Medical Center, Nashville (TN) USA
| | - Elisangela C. Silva1,5,6,7
- 1. Programa Acadêmico de Tuberculose, UFRJ, Rio de Janeiro (RJ) Brasil.5. Laboratório de Micobacteriologia Molecular, Hospital Universitário Clementino Fraga Filho, Instituto de Doenças do Tórax – HUCFF-IDT – Faculdade de Medicina, UFRJ, Rio de Janeiro (RJ) Brasil. 6. Laboratório Reconhecer Biologia, Centro de Biociência e Biotecnologia UENF, Campos dos Goytacases (RJ) Brasil. 7. Fundação Saúde do Estado do Rio de Janeiro, Secretaria de Saúde do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Afrânio Lineu Kritski1
- 1. Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Anna Cristina C. Carvalho1,2
- 1. Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil. 2. Laboratório de Inovações em Terapias, Ensino e Bioprodutos – LITEB – Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro (RJ) Brasil
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Gildner TE, Eick GN, Schneider AL, Madimenos FC, Snodgrass JJ. After Theranos: Using point-of-care testing to advance measures of health biomarkers in human biology research. Am J Hum Biol 2022; 34:e23689. [PMID: 34669210 DOI: 10.1002/ajhb.23689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 09/21/2021] [Accepted: 09/29/2021] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The rise and fall of the health technology startup Theranos is emblematic of the promise and peril of point-of-care testing (POCT). Instruments that deliver immediate results from minimally invasive samples at the location of collection can provide powerful tools to deliver health data in clinical and public health contexts. Yet, POCT availability is driven largely by market interests, which limits the development of inexpensive tests for diverse health conditions that can be used in resource-limited settings. These constraints, combined with complex regulatory hurdles and substantial ethical challenges, have contributed to the underutilization of POCT in human biology research. METHODS We evaluate current POCT capabilities and limitations, discuss promising applications for POCT devices in resource-limited settings, and discuss the future of POCT. RESULTS As evidenced by publication trends, POCT platforms have rapidly advanced in recent years, gaining traction among clinicians and health researchers. We highlight POCT devices of potential interest to population-based researchers and present specific examples of POCT applications in human biology research. CONCLUSIONS Several barriers can limit POCT applications, including cost, lack of regulatory approval for non-clinical use, requirements for expensive equipment, and the dearth of validation in remote field conditions. Despite these issues, we see immense potential for emerging POCT technology capable of analyzing new sample types and used in conjunction with increasingly common technology (e.g., smart phones). We argue that the fallout from Theranos may ultimately provide an opportunity to advance POCT, leading to more ethical data collection and novel opportunities in human biology research.
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Affiliation(s)
- Theresa E Gildner
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Geeta N Eick
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA
| | - Alaina L Schneider
- Department of Anthropology, Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - J Josh Snodgrass
- Department of Anthropology, University of Oregon, Eugene, Oregon, USA.,Center for Global Health, University of Oregon, Eugene, Oregon, USA
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Baluku JB, Ronald O, Bagasha P, Okello E, Bongomin F. Prevalence of cardiovascular risk factors in active tuberculosis in Africa: a systematic review and meta-analysis. Sci Rep 2022; 12:16354. [PMID: 36175540 PMCID: PMC9523035 DOI: 10.1038/s41598-022-20833-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
People with tuberculosis (TB) are at risk of major adverse cardiovascular events. We estimated the prevalence of cardiovascular risk (CVR) factors among people with active TB in Africa. This was a systematic review and meta-analysis of studies from Africa. We searched EMBASE, MEDLINE through PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, mRCTs, Clinical trials.gov, and International Clinical Trials Registry Platform from inception to 31st December 2021. Among 110 eligible studies, 79 (238,316 participants) were included in the meta-analysis for smoking, 67 (52,793 participants) for current alcohol use, 30 (31,450 participants) for hazardous alcohol use, 51 (37,879 participants) for diabetes mellitus (DM), 19 (18,211 participants) for hypertension and 18 (13,910 participants) for obesity. The pooled prevalence was 26.0% (95% confidence interval 22.0–29.0) for smoking, 30.0% (25.0–35.0) for any current alcohol use, 21.0% (17.0–26.0) for hazardous alcohol use, 14.0% (9.0–18.0) for hypertension, 7.0% (6.0–9.0) for DM, and 4.0% (2.0–5.0) for obesity. Cost-effective strategies are needed to screen for CVR factors among people with active TB in Africa.
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Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, PO Box 26343, Kampala, Uganda. .,Makerere University Lung Institute, Kampala, Uganda.
| | - Olum Ronald
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Peace Bagasha
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Felix Bongomin
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Awad SF, Critchley JA, Abu-Raddad LJ. Impact of diabetes mellitus on tuberculosis epidemiology in Indonesia: A mathematical modeling analysis. Tuberculosis (Edinb) 2022; 134:102164. [DOI: 10.1016/j.tube.2022.102164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 11/14/2021] [Accepted: 01/06/2022] [Indexed: 01/03/2023]
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Alemu A, Bitew ZW, Diriba G, Gumi B. Co-occurrence of tuberculosis and diabetes mellitus, and associated risk factors, in Ethiopia: a systematic review and meta-analysis. IJID REGIONS 2021; 1:82-91. [PMID: 35757829 PMCID: PMC9216412 DOI: 10.1016/j.ijregi.2021.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/11/2021] [Accepted: 10/13/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Ayinalem Alemu
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
- Corresponding author.
| | | | - Getu Diriba
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Balako Gumi
- Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
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Li M, Chen T, Hua Z, Yan H, Wang D, Li Z, Kang Y, Zhu N, Li C. Global, regional, and national prevalence of diabetes mellitus in patients with pulmonary tuberculosis: a systematic review and meta-analysis. Diabetol Metab Syndr 2021; 13:127. [PMID: 34717728 PMCID: PMC8557479 DOI: 10.1186/s13098-021-00743-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 10/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Both pulmonary tuberculosis (PTB) and diabetes mellitus (DM) are major global public health problems. We estimated the global, regional, and national prevalence of diabetes mellitus in a population with PTB. METHODS We searched for observational studies of DM in people with PTB using the PubMed and Embase electronic bibliographic databases, focusing on articles published in the English language from database inception until March 31, 2021. We included original research that reported the prevalence of DM in PTB or those that had sufficient data to compute these estimates. Studies were excluded if they did not provide primary data or were case studies or reviews. Two authors independently extracted the articles and collected detailed information using a predefined questionnaire. A country-specific random-effects meta-analysis was used for countries with two or more available studies, and a fractional response regression model was employed to predict the prevalence of DM in PTB for countries with one or no study. The study was registered with the International Prospective Register of Systematic Reviews, using the registration number CRD42018101989. RESULTS We identified 22,658 studies, and 153, across 51 countries, were retained for data extraction. The global prevalence of DM among patients with PTB was estimated to be 13.73% (95% confidence interval [CI] 12.51-14.95). The prevalence rates were 19.32% (95% CI 13.18-25.46) in the region of the Americas, 17.31% (95% CI 12.48-22.14) in the European region, 14.62% (95% CI 12.05-17.18) in Southeast Asia, 13.59% (95% CI 7.24-19.95) in the western Pacific region, 9.61% (95% CI 4.55-14.68) in the eastern Mediterranean region, and 9.30% (95% CI 2.83-15.76) in the African region. The country with the highest estimated prevalence was the Marshall Islands (50.12%; 95% CI 4.28-95.76). CONCLUSION Comorbid PTB and DM remain prevalent worldwide.
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Affiliation(s)
- Minmin Li
- Shaanxi Provincial Center for Disease Control and Prevention, No. 3 East Jian Road, PO Box 46, Xi'an, 710041, Shaanxi, People's Republic of China
| | - Tao Chen
- Department of Clinical Sciences, Liverpool School of Tropical Medicine Pembroke Place, Liverpool, UK
| | - Zhongqiu Hua
- Wuxi Early Intervention Center for Children with Special Needs, Wuxi, China
| | - Hong Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 West Yanta Road, PO Box 46, Xi'an, 710061, Shaanxi, People's Republic of China
- Nutrition and Food Safety Engineering Research Center of Shaanxi Province, Xi'an, China
| | - Duolao Wang
- Department of Clinical Sciences, Liverpool School of Tropical Medicine Pembroke Place, Liverpool, UK
| | - Zhaoqing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 West Yanta Road, PO Box 46, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Yijun Kang
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 West Yanta Road, PO Box 46, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Ni Zhu
- Shaanxi Provincial Center for Disease Control and Prevention, No. 3 East Jian Road, PO Box 46, Xi'an, 710041, Shaanxi, People's Republic of China.
| | - Chao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center, No. 76 West Yanta Road, PO Box 46, Xi'an, 710061, Shaanxi, People's Republic of China.
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Mabula PL, Kazinyingia KI, Chavala EC, Mosha V, Msuya SE, Leyaro BJ. Prevalence and risk factors for diabetes mellitus among tuberculosis patients in Moshi Municipal Council, Kilimanjaro Tanzania. East Afr Health Res J 2021; 5:69-74. [PMID: 34308247 PMCID: PMC8291211 DOI: 10.24248/eahrj.v5i1.653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/20/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Diabetes Mellitus (DM) is a worldwide public health problem and its prevalence has been rising rapidly in low and middle income countries (LMICs) including Tanzania. According to WHO report 2015, DM is ranked number six as a leading cause of death worldwide. Strong evidence suggests that DM may be associated with Tuberculosis (TB) and could affect TB treatment outcomes. Tanzania is among the 22 countries that have a high burden of TB and currently facing increased epidemic of DM. The increasing diabetes prevalence may be a threat to TB control and counteract strategies to end TB by 2030 as proposed by WHO. OBJECTIVE To determine proportion of TB patients who are co-infected with DM in Moshi municipal council, Kilimanjaro Tanzania. METHODOLOGY This study was a hospital based cross-sectional study conducted in April to July 2018 at 4 health facilities; Mawenzi Regional Referral hospital, St. Joseph District Designated hospital, Pasua Health center and Majengo Health centre in Moshi municipal. The study included adults aged 18 years and above attending either of the 4 health facilities for TB care. The study included newly diagnosed and those who were on TB treatment. Interviews were conducted followed by blood glucose testing. Data was entered and analysed using SPSS. RESULTS A total of 153 TB patients were enrolled, their mean age was 42.5 (±14.75) years and 46 (30.1%) were females. The prevalence of DM among TB patients in this study was 9.2%. Factors associated with TB-DM comorbidity were: age (OR 4.43, 95% CI: 1.18-16.55), HIV status (OR 3.88, 95% CI: 1.06-14.11), and family history of DM (OR 6.50, 95% CI 0.67-25.56). CONCLUSION One in ten patients with TB had confirmed DM. There is a need for future studies to assess if DM influences TB treatment and outcomes in this setting.
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Affiliation(s)
- Patrick L. Mabula
- Kilimanjaro Christian Medical University College (KCMUCo), Tanzania
- Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | | | | | - Victor Mosha
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sia E. Msuya
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Tanzania
- Community Health Department, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | - Beatrice John Leyaro
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Tanzania
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13
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Eckold C, Kumar V, Weiner J, Alisjahbana B, Riza AL, Ronacher K, Coronel J, Kerry-Barnard S, Malherbe ST, Kleynhans L, Stanley K, Ruslami R, Ioana M, Ugarte-Gil C, Walzl G, van Crevel R, Wijmenga C, Critchley JA, Dockrell HM, Cliff JM. Impact of Intermediate Hyperglycemia and Diabetes on Immune Dysfunction in Tuberculosis. Clin Infect Dis 2021; 72:69-78. [PMID: 32533832 PMCID: PMC7823074 DOI: 10.1093/cid/ciaa751] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 06/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND People with diabetes have an increased risk of developing active tuberculosis (TB) and are more likely to have poor TB-treatment outcomes, which may impact on control of TB as the prevalence of diabetes is increasing worldwide. Blood transcriptomes are altered in patients with active TB relative to healthy individuals. The effects of diabetes and intermediate hyperglycemia (IH) on this transcriptomic signature were investigated to enhance understanding of immunological susceptibility in diabetes-TB comorbidity. METHODS Whole blood samples were collected from active TB patients with diabetes (glycated hemoglobin [HbA1c] ≥6.5%) or IH (HbA1c = 5.7% to <6.5%), TB-only patients, and healthy controls in 4 countries: South Africa, Romania, Indonesia, and Peru. Differential blood gene expression was determined by RNA-seq (n = 249). RESULTS Diabetes increased the magnitude of gene expression change in the host transcriptome in TB, notably showing an increase in genes associated with innate inflammatory and decrease in adaptive immune responses. Strikingly, patients with IH and TB exhibited blood transcriptomes much more similar to patients with diabetes-TB than to patients with only TB. Both diabetes-TB and IH-TB patients had a decreased type I interferon response relative to TB-only patients. CONCLUSIONS Comorbidity in individuals with both TB and diabetes is associated with altered transcriptomes, with an expected enhanced inflammation in the presence of both conditions, but also reduced type I interferon responses in comorbid patients, suggesting an unexpected uncoupling of the TB transcriptome phenotype. These immunological dysfunctions are also present in individuals with IH, showing that altered immunity to TB may also be present in this group. The TB disease outcomes in individuals with IH diagnosed with TB should be investigated further.
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Affiliation(s)
- Clare Eckold
- Tuberculosis Centre and Department of Infection and Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Vinod Kumar
- University of Groningen, Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - January Weiner
- Max Planck Institute for Infection Biology, Berlin, Germany
| | - Bachti Alisjahbana
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
- Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Anca-Lelia Riza
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
- Human Genomics Laboratory, University of Medicine and Pharmacy, Craiova, Romania
- Regional Centre for Human Genetics–Dolj, Emergency Clinical County Hospital, Craiova, Romania
| | - Katharina Ronacher
- Mater Research Institute–University of Queensland, Translational Research Institute, Brisbane, Australia
- South Africa Medical Research Council Centre for Tuberculosis Research, Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jorge Coronel
- Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Sarah Kerry-Barnard
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Stephanus T Malherbe
- South Africa Medical Research Council Centre for Tuberculosis Research, Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Leanie Kleynhans
- South Africa Medical Research Council Centre for Tuberculosis Research, Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Kim Stanley
- South Africa Medical Research Council Centre for Tuberculosis Research, Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Rovina Ruslami
- TB-HIV Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Mihai Ioana
- Human Genomics Laboratory, University of Medicine and Pharmacy, Craiova, Romania
- Regional Centre for Human Genetics–Dolj, Emergency Clinical County Hospital, Craiova, Romania
| | - Cesar Ugarte-Gil
- Tuberculosis Centre and Department of Infection and Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Gerhard Walzl
- South Africa Medical Research Council Centre for Tuberculosis Research, Department of Science and Technology/National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, Division of Molecular Biology and Human Genetics, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Cisca Wijmenga
- University of Groningen, Department of Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Julia A Critchley
- Population Health Research Institute, St George’s, University of London, London, United Kingdom
| | - Hazel M Dockrell
- Tuberculosis Centre and Department of Infection and Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jacqueline M Cliff
- Tuberculosis Centre and Department of Infection and Biology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Correspondence: J. M. Cliff, Department of Infection Biology, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK ()
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Araia ZZ, Mesfin AB, Mebrahtu AH, Tewelde AG, Osman R, Tuumzghi HA. Diabetes Mellitus and Its Associated Factors in Tuberculosis Patients in Maekel Region, Eritrea: Analytical Cross-Sectional Study. Diabetes Metab Syndr Obes 2021; 14:515-523. [PMID: 33568928 PMCID: PMC7869713 DOI: 10.2147/dmso.s293557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/21/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Both diabetes mellitus (DM) and tuberculosis (TB) are among the leading causes of morbidity and mortality in Eritrea. TB-DM comorbidity is known to complicate TB care, control and prevention. However, systematically studied epidemiological data on TB-DM comorbidity and its associated risk factors are lacking in this country. OBJECTIVE This study aimed to assess the prevalence of DM and its associated factors among TB patients in the Maekel region, Eritrea. METHODS Analytical cross-sectional study was conducted in eleven TB diagnostic and treatment sites. Pretested data extraction tool was used to collect data from medical records. Prevalence data were analysed using frequencies, proportions and median. To determine DM risk factors, univariable and multivariable logistic regression analysis was done with 95% CI and p value < 0.05 considered significant. RESULTS Out of total eligible (1134) TB cases, DM prevalence was 9.88%. Age and BMI were identified as independent risk factors for DM among TB patients. Higher odds of DM were found among TB patients aged 45-54 (aOR: 4.85[1.39-16.94], p= 0.013) and those ≥55 (aOR: 6.99[2.12-23.04], p= 0.001). TB cases with normal BMI were two times more likely to have DM (aOR: 2.00[1.23-3.26], p= 0.005) compared to those underweight. CONCLUSION The prevalence of DM among TB cases observed in this study is high, a clarion call to scale up current efforts to integrate TB-DM services within routine care. Furthermore, age and BMI were identified as independent risk factors for DM in TB cases, pointing to the need to pay attention to age and BMI status when managing this co-morbidity.
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Affiliation(s)
- Zenawi Zeramariam Araia
- National TB and Leprosy Control Program, Communicable Disease Control Division, Ministry of Health, Asmara, Eritrea
- Correspondence: Zenawi Zeramariam Araia National TB and Leprosy Control Program, Communicable Diseases Control Division, Ministry of Health, Asmara, EritreaTel +291-1-122129 Email
| | | | - Amanuel Hadgu Mebrahtu
- National TB and Leprosy Control Program, Communicable Disease Control Division, Ministry of Health, Asmara, Eritrea
| | | | - Randa Osman
- Orrota College of Medicine and Health Sciences, Asmara, Eritrea
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Awad SF, Huangfu P, Ayoub HH, Pearson F, Dargham SR, Critchley JA, Abu-Raddad LJ. Forecasting the impact of diabetes mellitus on tuberculosis disease incidence and mortality in India. J Glob Health 2020; 9:020415. [PMID: 31673336 PMCID: PMC6815875 DOI: 10.7189/jogh.09.020415] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background In context of the rapidly expanding diabetes mellitus (DM) epidemic in India and slowly declining tuberculosis (TB) incidence, we aimed to estimate the past, current, and future impact of DM on TB epidemiology. Methods An age-structured TB-DM dynamical mathematical model was developed and analyzed to assess the DM-on-TB impact. The model was calibrated using a literature review and meta-analyses. The DM-on-TB impact was analyzed using population attributable fraction metrics. Sensitivity analyses were conducted by accommodating less conservative effect sizes for the TB-DM interactions, by factoring the age-dependence of the TB-DM association, and by assuming different TB disease incidence rate trajectories. Results In 1990, 11.4% (95% uncertainty interval (UI) = 6.3%-14.4%) of new TB disease incident cases were attributed to DM. This proportion increased to 21.9% (95% UI = 12.1%-26.4%) in 2017, and 33.3% (95% UI = 19.0%-44.1%) in 2050. Similarly, in 1990, 14.5% (95% UI = 9.5%-18.2%) of TB-related deaths were attributed to DM. This proportion increased to 28.9% (95% UI = 18.9%-34.1%) in 2017, and 42.8% (95% UI = 28.7%-53.1%) in 2050. The largest impacts originated from the effects of DM on TB disease progression and infectiousness. Sensitivity analyses suggested that the impact could be even greater. Conclusions The burgeoning DM epidemic is predicted to become a leading driver of TB disease incidence and mortality over the coming decades. By 2050, at least one-third of TB incidence and almost half of TB mortality in India will be attributed to DM. This is likely generalizable to other Asian Pacific countries with similar TB-DM burdens. Targeting the impact of the increasing DM burden on TB control is critical to achieving the goal of TB elimination by 2050.
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Affiliation(s)
- Susanne F Awad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Population Health Research Institute, St George's, University of London, London, UK
| | - Peijue Huangfu
- Population Health Research Institute, St George's, University of London, London, UK
| | - Houssein H Ayoub
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Department of Mathematics, Statistics, and Physics, Qatar University, Doha, Qatar.,Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Fiona Pearson
- Population Health Research Institute, St George's, University of London, London, UK
| | - Soha R Dargham
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, London, UK.,Joint senior authors
| | - Laith J Abu-Raddad
- Infectious Disease Epidemiology Group, Weill Cornell Medicine-Qatar, Cornell University, Qatar Foundation - Education City, Doha, Qatar.,Department of Healthcare Policy and Research, Weill Cornell Medicine, Cornell University, New York, New York, USA.,College of Health and Life Sciences, Hamad bin Khalifa University, Doha, Qatar.,Joint senior authors
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16
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Munseri PJ, Kimambo H, Pallangyo K. Diabetes mellitus among patients attending TB clinics in Dar es Salaam: a descriptive cross-sectional study. BMC Infect Dis 2019; 19:915. [PMID: 31664936 PMCID: PMC6820980 DOI: 10.1186/s12879-019-4539-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 10/09/2019] [Indexed: 01/15/2023] Open
Abstract
Background A bi-directional interaction between diabetes mellitus and tuberculosis is well established and has been likened to that between HIV and TB. Whereas HIV screening is standard of care test in sub Saharan Africa TB programs, the same is not true for diabetes mellitus (DM). Sub Saharan Africa, a region with high TB infection rates, is going through an epidemiological transition with rapidly rising prevalence of diabetes. We aimed at characterizing TB patients with DM in order to identify factors associated with TB-DM dual disease among patients attending TB clinics in Dar es Salaam. Methods A cross-sectional study was conducted between September 2016 and January 2017 among patients attending TB clinics in Dar es Salaam. We collected socio-demographic characteristics, anthropometric measurements and screened for diabetes by measuring fasting blood glucose that was followed by a 2 h postprandial glucose for participants with impaired fasting blood glucose. We examined for socio-demographic and clinical factors associated with diabetes using logistic regression analysis. Results Of the 660 enrolled participants with TB, 25 (3.8%) were on treatment for diabetes while 39 (6.1%) and 147 (23%) of the remaining 635 participants were ultimately diagnosed with DM and impaired fasting blood glucose respectively. The overall prevalence of DM was 9.7% (64/660). Independent risk factors for diabetes included: age > 44 years {OR 4.52, 95% CI: [1.28–15.89]}; family history of diabetes {OR 3.42, 95% [CI 1.88–6.21]}. HIV sero-positive TB patients were less likely to have DM compared to those who were HIV sero-negative {OR 0.35, 95% CI [0.17–0.73]}. Conclusions Screening for diabetes should be advocated for TB patients aged above 44 years and/or with a family history of diabetes. HIV sero-negative TB patients were more likely to have DM compared to those who were HIV sero-positive. Further studies are needed to confirm this observation and the underlying factors.
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Affiliation(s)
- Patricia J Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences Dar es Salaam, Box 65315, Dar es Salaam, Tanzania.
| | - Henrika Kimambo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences Dar es Salaam, Box 65315, Dar es Salaam, Tanzania
| | - Kisali Pallangyo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences Dar es Salaam, Box 65315, Dar es Salaam, Tanzania
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Hypoglycemic and Toxic Effect of Morus mesozygia Leaf Extract on the Liver and Kidneys of Alloxan-Induced Hyperglycemic Wistar Rats. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:6712178. [PMID: 32030095 PMCID: PMC6770302 DOI: 10.1155/2019/6712178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 08/20/2019] [Accepted: 08/28/2019] [Indexed: 01/30/2023]
Abstract
Purpose We investigated the hypoglycemic and toxic effect of Morus mesozygia leaf extract on the liver and kidneys of alloxan-induced hyperglycemic wistar rats. Method Phytochemical analysis was done. Diabetes was induced by the use of alloxan monohydrate in six groups of rats, i.e., 200 mg/kg, 400 mg/kg, 800 mg/kg, glibenclamide, normal saline, and normal control group. Blood glucose was measured at the time of inoculation, then at 1, 2, 3, and 4 hours after. After 14 days, rats were killed under anesthesia; blood collected for measurement of total protein, albumin, TAGs, cholesterol, AST, ALT, urea, and creatinine; and whole tissue of liver and kidneys used for histological studies. Results The extract possessed antidiabetic effects between 400 mg/kg and 800 mg/kg doses, which we attributed to the presence of flavonoids, tannins, terpenoids, and amino acids. There was a drop in total protein and albumin with no statistical significance (P ≥ 0.05). The changes in levels of ALT, TAGs, cholesterol, AST, creatinine, and urea were not statistically different from the standard diabetic drug. The extract was protective against histological damage as there were no significant lesions suggestive of toxicities in the liver and kidneys at doses below 800 mg/kg. Conclusion We established credible evidence that Morus mesozygia leaf extract has hypoglycemic effects between 400 mg/kg and 800 mg/kg and that it is safe on the liver and kidneys of wistar rats at doses less than 800 mg/kg.
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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: 33] [Impact Index Per Article: 6.6] [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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Asante-Poku A, Asare P, Baddoo NA, Forson A, Klevor P, Otchere ID, Aboagye SY, Osei-Wusu S, Danso EK, Koram K, Gagneux S, Yeboah-Manu D. TB-diabetes co-morbidity in Ghana: The importance of Mycobacterium africanum infection. PLoS One 2019; 14:e0211822. [PMID: 30730937 PMCID: PMC6366779 DOI: 10.1371/journal.pone.0211822] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 01/21/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Diabetes Mellitus (DM) is a known risk factor for tuberculosis (TB) but little is known on TB-Diabetes Mellitus (TBDM) co-morbidity in Sub-Saharan Africa. METHODS Consecutive TB cases registered at a tertiary facility in Ghana were recruited from September 2012 to April 2016 and screened for DM using random blood glucose and glycated hemoglobin (HbA1c) level. TB patients were tested for other clinical parameters including HIV co-infection and TB lesion location. Mycobacterial isolates obtained from collected sputum samples were characterized by standard methods. Associations between TBDM patients' epidemiological as well as microbiological variables were assessed. RESULTS The prevalence of DM at time of diagnosis among 2990 enrolled TB cases was 9.4% (282/2990). TBDM cases were significantly associated with weight loss, poor appetite, night sweat and fatigue (p<0.001) and were more likely (p<0.001) to have lower lung cavitation 85.8% (242/282) compared to TB Non-Diabetic (TBNDM) patients 3.3% (90/2708). We observed 22.3% (63/282) treatment failures among TBDM patients compared to 3.8% (102/2708) among TBNDM patients (p<0.001). We found no significant difference in the TBDM burden attributed by M. tuberculosis sensu stricto (Mtbss) and Mycobacterium africanum (Maf) and (Mtbss; 176/1836, 9.6% and Maf; 53/468, 11.3%, p = 0.2612). We found that diabetic individuals were suggestively likely to present with TB caused by M. africanum Lineage 6 as opposed to Mtbss (odds ratio (OR) = 1.52; 95% confidence interval (CI): 0.92-2.42, p = 0.072). CONCLUSION Our findings confirms the importance of screening for diabetes during TB diagnosis and highlights the association between genetic diversity and diabetes. in Ghana.
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Affiliation(s)
- Adwoa Asante-Poku
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana
| | - Prince Asare
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Legon, Accra, Ghana
| | | | - Audrey Forson
- Department of Chest Diseases, Korle-Bu Teaching Hospital, Korle-Bu, Accra, Ghana
| | - Pius Klevor
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Isaac Darko Otchere
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Sammy Yaw Aboagye
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Stephen Osei-Wusu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Emelia Konadu Danso
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Kwadwo Koram
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
| | - Sebastien Gagneux
- Department of Medical Parasitology and Infection Biology, Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Dorothy Yeboah-Manu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon Accra, Ghana
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Gadallah M, Amin W, Fawzy M, Mokhtar A, Mohsen A. Screening for diabetes among tuberculosis patients: a nationwide population-based study in Egypt. Afr Health Sci 2018; 18:884-890. [PMID: 30766551 PMCID: PMC6354872 DOI: 10.4314/ahs.v18i4.6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The prevalence of type 2 diabetes mellitus (DM) is increasing rapidly in Egypt and considered one of the major health problems in the Eastern Mediterranean region. Objectives To measure the prevalence of diabetes and detect the undiagnosed cases of diabetes mellitus among patient with tuberculosis. Methods Study Design: Nationwide population-based study. To diagnose DM among TB patients, we used a fasting blood sugar level of ≥ 126 mg/dl and a post-prandial blood glucose test result of ≥ 200 mg/dl. Results Screening for DM among 1435 TB patients' with no history of DM detected 30 new cases of DM, with a case detection rate of 2.09%. The highest screening yields were among TB patients aged ≥ 40 years, females and those with pulmonary TB. The number needed to screen (NNS) TB patients for detecting one new case of DM was 48 while the lowest values were for older age (NNS=27) and females (NNS=29). Conclusion Older age and being females and those with pulmonary type of TB were more prone to the double burden of TB and DM. Identifying cases with double burden of diseases will improve the proper management of both diseases and prevent complications.
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Affiliation(s)
- Mohsen Gadallah
- Community, Environmental and Occupational Medicine. Faculty of Medicine - Ain Shams University, Cairo 11566 Egypt
| | - Wagdy Amin
- Ministry of Health and Population - Chest Directorate, National Tuberculosis Control Program, Cairo, Egypt
| | - Magdy Fawzy
- Ministry of Health and Population - Chest Directorate, National Tuberculosis Control Program, Cairo, Egypt
| | - Alaa Mokhtar
- Ministry of Health and Population - Chest Directorate, National Tuberculosis Control Program, Cairo, Egypt
| | - Amira Mohsen
- National Research Center, Cairo, Egypt, Department of Community Medicine, Cairo, Egypt
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