Clinical challenges in the co-management of diabetes mellitus and tuberculosis in southern Africa

Reid, MJA; McFadden, Nikia R; Tsima, Billy

doi:10.1080/22201009.2013.10872319

Cited by 3 publications

(3 citation statements)

References 37 publications

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“…While the widespread use of ART is reducing HIV/AIDS related morbidity and mortality—especially due to TB co-infection which is the leading cause of death in HIV positive people—it could potentially fuel the resurgence of diabetes-associated TB [ 8 , 15 – 17 ]. The relationship between TB and DM is well established [ 18 ] and studies have shown that diabetes increases the risk of developing active TB, recurrent TB and severe TB disease and results in worse TB treatment outcomes [ 19 – 25 ].…”

Section: Introductionmentioning

confidence: 99%

Diabetes in a TB and HIV-endemic South African population: Analysis of a virtual cohort using routine health data

et al. 2021

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Background It is widely accepted that people living with diabetes (PLWD) are at increased risk of infectious disease, yet there is a paucity of epidemiology studies on the relationship between diabetes and infectious disease in SSA. In a region with a high burden of infectious disease, this has serious consequences for PLWD. Methods and findings Using routinely collected longitudinal health data, we describe the epidemiology of diabetes in a large virtual cohort of PLWD who have a high burden of HIV and TB, from the Khayelitsha subdistrict in the Western Cape Province in South Africa. We described the relationship between previous TB, newly diagnosed TB disease and HIV infection on diabetes using HbA1c results as an outcome measure. The study population was predominately female (67%), 13% had a history of active TB disease and 18% were HIV positive. The HIV positive group had diabetes ascertained at a significantly younger age (46 years c.f. 53 years respectively, p<0.001) and in general had increased HbA1c values over time after their HIV diagnosis, when compared to the HIV-negative group. There was no evidence of TB disease influencing the trajectory of glycaemic control in the long term, but diabetes patients who developed active TB had higher mortality than those without TB (12.4% vs 6.7% p-value < 0.001). HIV and diabetes are both chronic diseases whose long-term management includes drug therapy, however, only 52.8% of the study population with an HIV-diabetes comorbidity had a record of diabetes treatment. In addition, the data suggest overall poor glycaemic control in the study population with only 24.5% of the participants having an HbA1c <7% at baseline despite 85% of the study population being on diabetes treatment. Conclusion The epidemiologic findings in this exploratory study highlight the need for further research into diabetes outcomes in a high TB and HIV burden setting and demonstrate that routine health data are a valuable resource for understanding disease epidemiology in the general population.

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Section: Introductionmentioning

confidence: 99%

Diabetes in a TB and HIV-endemic South African population: Analysis of a virtual cohort using routine health data

et al. 2021

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“…Diabetic patients have the evidence of impaired cell-mediated immunity, micronutrient deficiency, pulmonary microangiopathy, and renal insufficiency, all of which predispose to pulmonary tuberculosis (PTB) [3, 4]. The stress of a severe chronic infection may enhance existing insulin resistance and unmask an underlying β -cell deficiency leading to hyperglycemia; therefore it is possible that the risk of DM is increased among people with TB, especially in the presence of other predisposing factors [5].…”

Section: Introductionmentioning

confidence: 99%

Diabetes Mellitus among Adult Tuberculosis Patients Attending Tuberculosis Clinics in Eastern Ethiopia

Tenaye

Mengiste

Baraki

et al. 2019

BioMed Research International

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Background Developing countries are suffering from the previously existing infectious diseases and alarmingly growing burden of noncommunicable diseases like diabetes mellitus. There is increased speculation that diabetes mellitus might attribute to high infectious diseases burden, such as tuberculosis. The global importance of diabetes mellitus as a tuberculosis-risk factor is still not a well-established fact. Thus, we conducted this study to determine the prevalence of diabetes mellitus and its associated factors among adult tuberculosis patients attending tuberculosis clinics. Methodology We conducted a cross-sectional survey, from March 10 to April 15, 2017, among 421 tuberculosis patients receiving tuberculosis treatment in health facilities of Dire Dawa City Administration Council, Eastern Ethiopia. Study participants were selected using systematic random technique, and data were collected using a structured questionnaire. Fasting blood sugar and anthropometric measurements were carried out for all participants. A logistic regression analysis was performed to identify factors associated with diabetes mellitus. Result The prevalence of diabetes mellitus in this study was 13.5%. Age 26–40 (AOR = 6, 95% CI: (1.28, 27.5)), age ≥41(AOR = 9, 95% CI: (1.9, 44.4)), and family history of diabetes (AOR = 3.14, 95% CI: (1.23, 8.02)) were found to have a significant association with diabetes mellitus. Conclusion This study found that the magnitude of diabetes mellitus among tuberculosis patients was higher than the national estimated prevalence of diabetes mellitus in Ethiopia. This study suggests the need for screening each tuberculosis patient for diabetes.

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“…Although the biological association of TB and DM is not fully understood, studies suggest that diabetes depresses immune responses, which in turn facilitates infection with Mycobacterium tuberculosis ( M. tuberculosis ) and/or progression to symptomatic disease. This is corroborated by the fact that diabetes is generally diagnosed before TB develops [ 5 , 6 ]. Additionally, poor glycemic control adversely affects TB treatment outcomes with effects such as prolongation of culture conversion, treatment failure, relapse, and death [ 7 ].…”

Section: Introductionmentioning

confidence: 97%

Diabetes mellitus and HIV infection among active tuberculosis patients in Northwest Ethiopia: health facility-based cross-sectional study

et al. 2021

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Background The prevalence of diabetes mellitus (DM) is increasing globally and its comorbidity with tuberculosis (TB) is re-emerging, especially in low- and middle-income countries. Objective The main aim of this study is to determine the prevalence of DM and HIV infection and their associated risk factors among active tuberculosis patients in Northwest Ethiopia. Methods This hospital-based cross-sectional study was conducted between February 1st and June 30th, 2017 among active TB patients in two hospitals of Northwest Ethiopia. Two hundred and sixty-seven active TB cases aged 18 years or older were screened for diabetes using fasting blood glucose (FBG) test. Semi-structured questionnaires were used to collect demographic data, lifestyle habits and clinical data. Identification of pre-diabetes or diabetes in TB patients was achieved according to American Diabetes Association guidelines (2016). Results Prevalence of DM and TB comorbidity was 11.5% (95% confidence interval, CI 7.8–15.2) compared to 24.9% (95% CI 20.1–30.1) for pre-diabetes. Prevalence of HIV/TB co-infection was 21.9% (95% CI 16.7–26.8). Risk of DM was higher in TB patients from a rural location (adjusted odds ratio, aOR 3.13, 95% CI 1.02–9.62, p = 0.046). Similarly, DM was higher in TB patients who have a family history of DM (aOR 4.54, 95% CI 1.31–15.68, p = 0.017). Furthermore, HIV/TB co-infection was identified as a predictor of DM comorbidity in active TB patients (aOR 5.11, 95% CI 2.01–12.98, p = 0.001). Conclusion The magnitude of DM and pre-diabetes in active TB patients in Northwest Ethiopia was high, warranting collaborative efforts to improve screening and adopt better clinical management strategies for DM–TB comorbid patients. Furthermore, being rural residents, family history of DM and HIV/TB co-infection were found to associate with DM among TB patients, highlighting the importance of the above-mentioned risk factors in the clinical management of this comorbidity.

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Clinical challenges in the co-management of diabetes mellitus and tuberculosis in southern Africa

Cited by 3 publications

References 37 publications

Diabetes in a TB and HIV-endemic South African population: Analysis of a virtual cohort using routine health data

Diabetes in a TB and HIV-endemic South African population: Analysis of a virtual cohort using routine health data

Diabetes Mellitus among Adult Tuberculosis Patients Attending Tuberculosis Clinics in Eastern Ethiopia

Diabetes mellitus and HIV infection among active tuberculosis patients in Northwest Ethiopia: health facility-based cross-sectional study

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