Cohort profile: the diabetes-tuberculosis treatment outcome (DITTO) study in Pakistan

Abstract

PurposePakistan is faced with an increasing prevalence of diabetes in addition to its existing high burden of tuberculosis (TB). Diabetes has a detrimental effect on treatment outcomes of patients with TB, which may hinder achieving the goals of the End-TB strategy by 2030. We conducted a prospective cohort study to determine difference between treatment outcomes among patients with diabetes and new pulmonary tuberculosis (PTB) and patients without diabetes and new PTB. This would help generate contextual and valid scientific evidence from a developing country like Pakistan with its unique interplay of sociocultural, economic and health system factors to inform policy and practice.ParticipantsThis paper outlines the baseline characteristics of 614 new cases of PTB, aged 15 years and older, which were followed up prospectively at 2nd, 5th and 6th months while on antituberculosis treatment and at 6 months after treatment completion.Findings to dateWe ascertained patients' diabetic status by conducting random and fasting blood glucose tests and their glycaemic control by determining glycosylated haemoglobin. Treatment outcomes were established using standardised definitions provided by WHO. The assessment of 614 respondents' diabetic status revealed that 113 (18%) were diabetic and 501 (82%) were non-diabetic. A greater proportion of patients with diabetes and PTB were illiterate (n=74/113, 65.5%) as compared to patients without diabetes and PTB (n=249/501, 50%) (p=0.035). More patients with diabetes and PTB gave a history of heart disease (n=14/113, 12%) and hypertension (n=26/113, 23%) as compared to patients without diabetes and PTB (n=2/501, 0.4% (heart disease) and n=13 501, 3% (hypertension)) (p<0.001). Unfavourable treatment outcome was more likely among patients with diabetes and PTB (n=23/93, 25%) as opposed to patients without diabetes and PTB (n=46/410, 11%) (p=0.001).Future plansWe are negotiating with the government regarding funding for a further 2-year follow-up of the cohort to ascertain death and relapse in the post-treatment period and also differentiate between re-infection and recurrence among these patients with respect to their diabetic status.

Did diabetes mellitus affect treatment outcome in drug-resistant tuberculosis patients in Pakistan from 2010 to 2014?

“…[11][12][13][14] Recent studies in Pakistan have shown more unfavourable outcomes among DS-TB patients with DM; 15,16 however, we could not find any relevant study examining the effect of DM on treatment outcomes among DR-TB patients in Pakistan.…”

Association amid the comorbidity of Diabetes Mellitus in patients of Active Tuberculosis in Pakistan: A matched case control study

“…Nations, belong to the developing part of the world is continuously struggling to combat these chronic conditions due to high prevalence and growing epidemics because of rapid economic, social and life style changes. 12 Studies conducted in Brazil, China and Peru are in line with the results of this research and observed a positive DM-TB association with much higher results. 7,[13][14][15] Anti-tuberculosis medicines worsen the glycemic control and diabetes can cause relapse or worsen the clinical course of TB, that might be a reason of strong positive association, as both conditions are more prevalent in developing countries individually or as comorbid.…”

Risk of adverse treatment outcomes among new pulmonary TB patients co-infected with diabetes in Pakistan: A prospective cohort study

“…The details of study methods have been published previously [ 19 ]. Briefly, the DITTO study was a prospective cohort study undertaken in October 2013 at Gulab Devi Chest Hospital (GDH), a tertiary care hospital in Lahore, Pakistan.…”