High Diabetes Prevalence among Tuberculosis Cases in Kerala, India (original) (raw)
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Public Health Action, 2013
Setting: Tertiary care hospital for diabetes mellitus (DM) in Tamil Nadu, South India. Objective: To compare the socio-demographic, clinical and biochemical characteristics in DM patients with and without tuberculosis (TB). Design: A descriptive study involving a review of routinely maintained records to capture the results of screening of DM patients for TB between March and December 2012. DM patients were first asked whether they already had TB, and if not they were screened for TB symptoms, followed by investigations for and possible diagnosis of TB. Results: Of 7083 DM patients, 38 already had TB. Of the remainder, 125 (1.8%) had TB symptoms; 71 were investigated and 12 were newly diagnosed with TB. Of the 50 TB patients, 64% had smear-positive pulmonary TB (PTB). DM-TB patients were older, and had lower education level and economic status, a higher frequency of alcohol use, lower body mass index, a longer duration of DM, a greater likelihood of receiving insulin and poorer glycaemic control. Conclusion: Screening of DM patients for TB was feasible in a tertiary care hospital. The yield of new TB cases was low and merits further investigation. Socio-demographic and clinical characteristics were different in patients with DM and TB compared to those with DM only.
Journal of Family Medicine and Primary Care, 2018
Context: Tuberculosis (TB) and diabetes mellitus (DM) remain a global public health problem. India has the largest number of TB cases; in 2015, out of total global annual incidence of 9.6 million TB cases, 2.2 million were estimated from India. There are 62.4 million people with type 2 diabetes and 77 million people with prediabetes in India, and these numbers are projected to increase to 101 million by the year 2030. Diabetes and TB affect each other at many levels. Screening for diabetes in patients with TB will not only help in early case detection but also better management of both comorbidities. Aims: (i) To determine the prevalence of diabetes and prediabetes among diagnosed cases of TB registered under RNTCP in Bhopal district. (ii) To determine additional yield of previously unknown DM and the number needed to screen (NNS) to find out a new case of DM. (iii) To find out the factors associated with diabetes among patients diagnosed with TB registered under RNTCP in Bhopal district. Settings and Design: This study was a cross-sectional study conducted on registered patients with TB under RNTCP in two TB units of Bhopal district. Materials and Methods: Participants were contacted and interview was conducted after obtaining consent using predesigned and pretested performa during the period of 1 st October 2014 to 30 th March 2015 for a period of 6 months. Statistical Analysis Used: Continuous variable were summarized as frequency, mean, and standard deviation. All variables were analyzed using Chi-square test of significance; P < 0.05 was taken as statically significant. Result: Of the total 528 patients with TB, 296 was male and 232 were female. Of the total, 63 (11.9%) patients were diagnosed as diabetic. NNS to diagnose a new case of DM was 22.1. Significant association was found with six variables which are age, sex, body mass index, type of TB, category of TB, and smoking. Conclusion: This study shows feasibility and importance of screening of patients with TB in existing program settings.
Public Health Action, 2013
Setting: Two tertiary care hospitals and 12 peripheral health institutions (PHIs) in Trivandrum, Kerala, India. Objective: To determine factors associated with the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients and examine differences in the proportion of new DM cases among TB patients diagnosed at tertiary care centres and PHIs. Design: A descriptive study: TB patients diagnosed during March-September 2012 were screened for known DM. Those with unknown DM status were tested for random blood glucose and fasting blood glucose (FBG); FBG ⩾ 126 mg/dl was diagnosed as new DM. Results: Of 920 TB patients, 689 (72%) were male and the mean (standard deviation) age was 47.6 (16.4) years. Of these, 298 (32.4%) were diabetic: 235 (26%) had previously known DM and 63 (7%) were newly diagnosed. During the screening at PHIs and tertiary care hospitals, respectively 30/183 (16.4%) and 33/737 (4.5%) were newly diagnosed with DM (OR 3.71; 95%CI 2.17-6.32). Overall, age >50 years and pulmonary tuberculosis were independently associated with a higher prevalence of diabetes. Conclusion: As nearly one in three TB patients had DM, we recommend that TB patients should be routinely screened for DM in Kerala. As the proportion of new DM was higher among TB patients diagnosed at PHIs, we would recommend that specific attention and investment be directed to PHIs. AFFILIATIONS * Adjusted for age, sex, type of TB, smoking status and site of diagnosis. † P < 0.05. DM = diabetes mellitus; TB = tuberculosis; OR = odds ratio; CI = confidence interval; PHI = peripheral health institution.
PLoS ONE, 2012
Background: Diabetes mellitus (DM) is recognised as an important risk factor to tuberculosis (TB). India has high TB burden, along with rising DM prevalence. There are inadequate data on prevalence of DM and pre-diabetes among TB cases in India. Aim was to determine diabetes prevalence among a cohort of TB cases registered under Revised National Tuberculosis Control Program in selected TB units in Tamil Nadu, India, and assess pattern of diabetes management amongst known cases. Methods: 827 among the eligible patients (n = 904) underwent HbA1c and anthropometric measurements. OGTT was done for patients without previous history of DM and diagnosis was based on WHO criteria. Details of current treatment regimen of TB and DM and DM complications, if any, were recorded. A pretested questionnaire was used to collect information on sociodemographics, habitual risk factors, and type of TB. Findings: DM prevalence was 25.3% (95% CI 22.6-28.5) and that of pre-diabetes 24.5% (95% CI 20.4-27.6). Risk factors associated with DM among TB patients were age (31-35, 36-40, 41-45, 46-50, .50 years vs ,30 years) [OR (95% CI) 6.75
PLOS ONE
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 coprevalence. 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 1 st 2015 and June 30 th 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
Tuberculosis screening among persons with diabetes mellitus in Pune, India
BMC infectious diseases, 2017
Diabetes mellitus (DM) increases tuberculosis (TB) risk, and there is increasing concern over the public health implications of the convergence of these two epidemics. Screening for TB among people with DM is now recommended in India. People with DM seeking care at a large public sector tertiary care hospital clinic in Pune, India, were screened for TB from June 2015 to May 2016. All consenting people with DM were screened for TB at each clinic visit using a five-item, WHO-recommended questionnaire and those with TB symptoms and/or risk factors were tested for active TB using sputum smear microscopty, Xpert® MTB/RIF and TB culture. Categorical data and continuous variables were summarized using descriptive statistics. The x (2) test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively. Among 630 adults approached for screening, median age was 60 (interquartile range (IQR), 57-64) years and 350 (56%) were ...
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease, 2018
Pre-diabetes mellitus (pre-DM) and DM increase the risk of developing tuberculosis (TB). Screening contacts of TB patients for pre-DM/DM and linking them to care may mitigate the risk of developing TB and improve DM management. To measure the prevalence of pre-DM/DM and associated factors among the adult household contacts (HHCs) of pulmonary TB patients. Between August 2014 and May 2017, adult HHCs of newly diagnosed adult PTB patients in Pune and Chennai, India, had single blood samples tested for glycosylated haemoglobin (HbA1c) at enrolment. DM was defined as previously diagnosed, self-reported DM or HbA1c 6.5%, and pre-DM as HbA1c between 5.7% and 6.4%. Latent tuberculous infection (LTBI) was defined as a positive tuberculin skin test (5 mm induration) or QuantiFERON® Gold In-Tube (0.35 international units/ml). Of 652 adult HHCs, 175 (27%) had pre-DM and 64 (10%) had DM. Forty (64%) HHCs were newly diagnosed with DM and 48 (75%) had poor glycaemic control (HbA1c 7.0%). Sixt...
National Journal of Medical Research, 2018
Background: Type 2 Diabetes mellitus (T2DM) and Tuberculosis (TB) often manifest together leading to complications at various levels. Methods: In this prospective study, we determined the incidence of TB among 1200 patients with type 2 diabetes attending the Capital Hospital of Bhubaneswar. Various socio-demographic factors like age, gender, marital status, literacy status, locality, habits, etc. and clinical profile were assessed. Results: Out of 1200 patients with type 2 diabetes mellitus, only 13 were having active TB disease, the incidence being 1.08%. Further, 12 were having pulmonary TB. More males with advancing age and sedentary life style were having Diabetes. About 23% of patients had familial history, high BMI levels, hypertension, high FBG levels, cholesterol and triglyceride levels. 30% of T2DM patients were having metabolic syndrome. In our study, age, literacy status, occupation, life style, familial history, habits and stress appeared to be significant risk factors among patients with diabetes. The HbA1C levels were higher among 51% of the diabetes patients. It was observed that while 84% of the patients were taking oral hypoglycemic drugs only 8% were taking Insulin injections. These patients were addicted to either smoking, drinking alcohol and/or chewing tobacco / gutka. The HbA1C levels were higher among 69% of the DM-TB patients indicating poorer glycemic control which is a proven risk factor for TBDM co-morbidity. Conclusions: Screening for DM in TB patients could improve case detection of diabetes and early treatment, which in turn will lead to better TB-specific treatment outcomes and prevention of diabetes related complications.
International Journal Of Community Medicine And Public Health
Background: The aim of the study was to assess the feasibility and results of screening diabetes mellitus (DM) patients for tuberculosis (TB) and TB patients for DM within the routine health care settings. Methods: Prospective observational study was carried out within the Diabetes Centre and TB division from June, 2014 to June, 2016. The screening for active TB in DM and DM in TB patients is followed as per the guidelines of the revised national tuberculosis control programme and national programmes in India. Results: 350 patients with active TB disease were screened for diabetes during the study period. Among the TB patients, 28% patients were having pre-diabetes and 17% patients were having diabetes. Both the conditions, pre-Diabetes or diabetes, were more common among males, married patients, advancing age, having less education, no specific job, sedentary life style, smoking / drinking, living in crowded areas, poor living conditions as well as unhygienic environment. 350 patie...
Tuberculosis-diabetes screening: how well are we doing? A mixed-methods study from North India
Public Health Action, 2019
Objectives: To assess 1) the proportion of tuberculosis (TB) patients screened for diabetes mellitus (DM) and vice versa, 2) factors associated with screening, and 3) the enablers, barriers and solutions related to screening. Design: A mixed-methods study with quantitative (cohort study involving record reviews of patients registered between November 2016 and April 2017) and qualitative (interviews of patients, health care providers [HCPs] and key district-level staff) components. Results: Screening for TB among DM patients was not implemented, despite documents indicating that it had been. Of 562 TB patients, only 137 (24%) were screened for DM. TB patients registered at tertiary and secondary health centres were more likely to be screened than primary health centres. Low patient awareness, poor knowledge of guidelines among HCPs, lack of staff and inadequate training were barriers to screening. Enablers were the positive attitude of HCPs and programme staff. The key solutions suggested were to improve awareness of HCPs and patients regarding the need for screening, training of HCPs and wider availability of DM testing facilities. Conclusion: The implementation of bidirectional screening was poor. Adequate staffing, regular training, continuous laboratory supplies for DM diagnosis and widespread publicity should be ensured.