Background. Increased susceptibility of diabetic mellitus (DM) patients to infection, including tuberculosis (TB), is well documented. The prevalence of DM in Malaysia is reaching epidemic proportions. In this study, we sought to assess risk factors for TB and the impact of DM on the outcome of TB treatment. Methods. TB patients, diabetic patients, and diabetic patients with TB were divided into three groups of 200 subjects each. Data were obtained from patients' medical files at the beginning and end of the study period. Prevalence rates of DM and HIV among TB patients were assessed. Prognosis, TB-related complications, anatomical site of infection, and duration of infection and diabetes were also examined. Results. The prevalence rates of HIV and DM amongst TB patients were 7.7 and 30%, respectively. The diabetic TB patient group contained more males (72%) and smokers (45.5%) compared to the nondiabetic group (58.3% and 33.5%, resp.). Approximately 74% of diabetic patients were Mycobacterium sputum positive compared to only 51% of nondiabetic patients. Diabetic patients were also more likely to develop pulmonary TB (87%) compared to nondiabetic TB patients (59%). Diabetic TB patients had a higher mortality rate (7.5%) compared to the TB only and DM only groups (1 and 2%, resp.). The duration of TB symptoms was longer in nondiabetic TB patients compared to diabetic TB patients (4.5 versus 2.6 months, resp.). Diabetes antedated TB by a mean time of 4 years. Conclusions. We found a higher number of sputum-smear-positive cases and pulmonary TB cases as well as a greater number of males and higher mortality rate in diabetic patients compared to nondiabetic patients.

Aim:To assess the impact of diabetes mellitus (DM) on the cost of the tuberculosis (TB) treatment. Study Design: Prevalence based cohort Place and Duration of Study: Methods: Study patients were placed in the TB only, DM only, or DM-TB groups,with each group including 200 patients. Information related to demographics, chronic disease comorbidity, duration of hypertension (HTN) and DM, and economic variables were obtained from the patients' medical files both at the beginning and end of the study period. The economic burden of DM-TB patients was assessed from hospitalization periods, frequency of clinic visits, and diagnostic requests. Results: Durations of DM and HTN were 9.2 and 5.6 years, respectively, for the DMonly group compared to 5.3 and 1.1 years, respectively, for DM-TB subjects. For both diabetic groups, diabetes preceded HTN, with onset of HTN occurring approximately 4 years after patients were diagnosed diabetic. Approximately 86% of DM only subjects suffered additional comorbidity, and 44.5% had three or more coexisting chronic diseases compared to 56% and 11.4%, respectively, in the DM-TB group. The hospitalization period was 10.2 days for the DM-TB group compared to 7 and 4 days for the TB only Research Article1599 and DM only groups, respectively; however, 43% of TB only subjects needed surgical intervention compared to 17% in the DM-TB group. The total cost wasRM4530 (US$1234.3) for the DM-TB group compared to RM3082.8 (US$840) and RM6945.26 (US$1892.40) for theTB only and DM only groups, respectively. Conclusions: DM antedated HTN in our patients. Durations of both DM and HTNwere longer for the DM only group. The number of diagnosed chronic diseases and overall treatment cost was higher in the DM-TB group compared to TB only group, but lower compared to the DM only group. The TB only group required the most surgical intervention.

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Introduction: Tuberculosis (TB) is one of the leading cause of death among infectious diseases. The dual burden of TB and diabetes mellitus (DM) is a major economic and health concern. Anti-TB therapy may predispose patients to develop adverse drug reaction (ADR). The effect of DM on anti-TB ADR requires more studies. Methods: We performed a cross-sectional study and followed patients for at least two  years. Patients were selected from three Malaysian teaching hospitals. TB patients, and diabetic patients with TB were divided into two groups of 200 subjects each. Data were obtained from patients’ medical files at the beginning and end of the study  period. Prevalence of serious adverse drug reaction (ADR) requiring dose adjustment was assessed. Results: ADR in our subjects was documented in the medical records and confirmed by a system known as Challenge. The prevalence rates of ADR amongst DM-TB and TB only patients were 16.5% and 14.8%, respectively, but the difference was not significant (Fisher E.T: P > 0.05). ADR was more frequent with streptomycin treatment, partially because of its painful administration. Isoniazid treatment showed the least frequency of ADR. Conclusion: Although the frequency of ADR was high among DM-TB patients, it was not significantly different to that among TB only patients.

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