Mishra, Munje, Dawkore - 2018 - Diabetes and Tuberculosis – Tackling Double Trouble.pdf (original) (raw)
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Incidence of Tuberculosis in Diabetic patients in Kolkata, India – a pilot study
Background & Objective – Tuberculosis (TB) and diabetes two of the most prevalent diseases worldwide and may occur concurrently. The association between TB & diabetes are known historically though from 18 th century onwards it is being studied in a more scientific manner. The objective of this study is to determine incidence of TB in diabetic patients and also to understand comorbid correlation. Materials & Methods-This is a retrospective cross sectional study carried out at the Respiratory medicine department of Medical College between November 2017 and December 2017. Results – Overall incidence of TB in diabetic patients was found to be 8.33%. Incidence rate of TB in Type I diabetes was 34.28% and in Type II diabetes was 8.49% (odds ratio 5.25). Fever as a presenting feature found to be more common in diabetic tuberculosis group (odds ratio 6.8333, 95% C.I 1.6535 to 28.2403, p = 0.0079). Diabetic tuberculosis group is more prone to develop cough in comparison to patients with only diabetes (Odds ratio 11.1724, 95% C.I 2.24 to 55.699, p= 0.0032). Chest pain, Respiratory distress and Haemoptysis are also more common in diabetic tuberculosis group (Odds ratio of 5.25, 153 and 6.66 respectively). Study results also showed that diabetic patient with TB have worse glycaemic control compared to patients suffering from only diabetes (Odds ratio 9.75, 95% C.I 1.9622 to 48.4476, p = 0.0054). Conclusion – TB and diabetes are both prevalent in Kolkata. In our country, large scale prospective cohort studies are needed to understand this relationship more vividly to develop better management protocols in future.
International Journal of Research in Medical Sciences, 2022
Background: Diabetes (DM) can worsen the clinical course of tuberculosis (TB) and treatment outcomes in terms of increased deaths, treatment failure, and relapse rates. This study investigated the prevalence of DM in TB patients at an urban primary health centre (UPHC), Delhi and the factors associated with it. Methods: A record-based study of all TB patients registered from December 2019 to November 2020 at a directly observed treatment short-course (DOTS) center of a UPHC in Delhi was conducted. Information regarding sociodemographic details and disease profile, diabetes status and random blood sugar level was collected from patients' treatment cards. Data were entered and analyzed in SPSS. Descriptive analysis was done. Results: A total of 252 patients were registered at the DOTS center during one year and data for all of them were analyzed. The mean age of the study participants at the time of the study was 31.13±15.84 years, half of them were males (56%) and the site of the disease was predominantly pulmonary (61%). Out of 252 TB patients, 17 (7%) and 2 (1%) were diabetics and pre-diabetics respectively. Conclusions: Those patients with age more than 30 years, pulmonary TB, sputum positive TB are the factors with statistically significant association with diabetes in our study.
Diabetes Mellitus and Tuberculosis Treatment Outcomes in Pune, India
Open Forum Infectious Diseases
Background Diabetes mellitus (DM) increases the risk of tuberculosis (TB) disease. Knowledge of the impact of DM on TB treatment outcomes is primarily based on retrospective studies. Methods We conducted a prospective cohort study of new pulmonary TB patients with and without DM (TB-DM and TB only) in India. The association of DM with a composite unfavorable TB treatment outcome (failure, recurrence, mortality) over 18 months was determined, and the effect of DM on all-cause mortality and early mortality (death during TB treatment) was assessed. Results Of 799 participants, 574 (72%) had TB only and 225 (28%) had TB-DM. The proportion of patients with DM who experienced the composite outcome was 20%, as compared with 21% for TB-only participants (adjusted hazard ratio [aHR], 1.13; 95% CI, 0.75–1.70). Mortality was higher in participants with DM (10% vs 7%), and early mortality was substantially higher among patients with DM (aHR, 4.36; 95% CI, 1.62–11.76). Conclusions DM was associa...
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
Journal of Family and Community Medicine, 2020
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.
Effect of type II diabetes mellitus on treatment outcomes of tuberculosis
Lung India, 2014
40.9 million diabetics in 2006 and an estimated 70 million in 2025. [3] An epidemiological modelling study reported increased incidence of TB among those with diabetes in India. [4] Thus, rising DM is expected to fuel incidence of TB even further. Multiple studies of TB treatment have indicated that patients with diabetes mellitus may experience poor outcomes. [5] However, some others had contradictory evidence. A study in India under controlled environment inferred that neither diabetes nor HIV co-morbidity interfere with course or outcome of TB. [6] A systematic review of these studies suggested that DM increases the risk of failure and death combined, death, and relapse among patients with TB. However, most studies in this review were retrospective studies which relied on medical records for presence of DM. We conducted a prospective study to assess the influence of diabetes on the treatment outcomes of TB under field conditions, among those taking Directly Observed Treatment Short course (DOTS) under Revised National Tuberculosis Control Programme (RNTCP) in Cuddalore district of Tamil Nadu (TN). Context: There is conflicting evidence of effect of diabetes on treatment of tuberculosis (TB). There is a need to investigate effect of diabetes on outcomes of TB treatment under field conditions in India. Aims: To compare treatment outcomes among TB patients with diabetes with those without diabetes. Setting and Design: Study was conducted in Cuddalore, Tamil Nadu, among patients registered with Revised National TB Control Programme. Prospective observational study design was used. Materials and Methods: Registered TB patients aged 30 and above were invited to participate in the study. Those who were not aware of their diabetic status were diagnosed using oral glucose tolerance test. A total of 89 diabetic and 120 non-diabetic patients were recruited in the study. They were followed up till the end of treatment and outcomes were recorded. Statistical Analysis Used: Treatment outcomes in the two groups were compared using bivariate and multi-variate analysis. Results: Bi-variate (unadjusted) analysis showed similar treatment success rates in the two groups. But, the adjusted odds ratios for successful treatment among diabetic patients were significantly lower (0.191, 95% CI 0.04-0.90) for pulmonary TB patients and for smear positive pulmonary TB patients (odds ration 0.099, 0.013-0.761). Diabetes was found to be predictor for sputum positivity at end of treatment. Conclusions: Diabetes increases risk of poor treatment outcomes among pulmonary TB patients. The study highlights need of screening of TB patients for diabetes. There is need to see the effect of glycemic control on treatment outcomes among diabetics.
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 Research in Medical Sciences
Background: Many studies reported association between TB susceptibility and diabetes mellitus (DM). Some studies were retrospective, did not assess other co morbidities related with tuberculosis. The effects of diabetes on tuberculosis severity (EDOTS) can be hypothesizing that burden of cases India is leading in TB and runner-up in diabetic. We report interim findings after enrolling 732 of a planned 212 subjects.Methods: This study conducted on patients with TB in west India with DM and normoglycemia defined by glucose tolerance test (GTT) and glucose fasting. Glycocylated hemoglobin (HbA1c), lipids profile and 25-hydroxyvitamin D were measured at the time of enrollment of patients. All patients were monitored monthly while they visited in TB and chest clinic for TB treatment.Results: Of 212 eligible patients, 117 (55.18%) were classified as diabetic, 49 (23.11%) with pre diabetic history (PDM), and 46 (21.70%) as normoglycemic (NG). DM patients were more likely to have a family h...
2014
Recently several publications have been pronounced the relationship among Diabetes mellitus and tuberculosis patients, certainly the rise in the frequency of dynamic Diabetes mellitus in patients with tuberculosis and due to minor cure leading in Diabetes mellitus patients compared to those having no diabetic disorder. This research study was accompanied in the outpatient clinic shortened directly observed therapy (DOTS) center Kohat. Diabetes mellitus 1 Corresponding author: dr.nafisa.tahir@gmail.com Nafisa Batool Tahir, Qazi Tahir Uddin, Syed Sajid Munir, Abdul Waheed, Saqib Waheed, Hidayatullah, Muhammad DaudPrevalence of Diabetes Mellitus in tuberculosis patients at DOTS regional centre KMU-IMS teaching Hospital Kohat EUROPEAN ACADEMIC RESEARCH Vol. II, Issue 7 / October 2014 9949 individualls were arbitrarily selected by simple random sampling technique, the history and risk factors were collected through consent Questionnaire and blood samples were collected by nurse and were ...
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