Diabetes among tuberculosis patients and its impact on tuberculosis treatment in South Asia: a systematic review and meta-analysis

Abstract

The escalating burden of diabetes is increasing the risk of contracting tuberculosis (TB) and has a pervasive impact on TB treatment outcomes. Therefore, we conducted this systematic review and meta-analysis to examine the burden of diabetes among TB patients and assess its impact on TB treatment in South Asia (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, India, Pakistan, and Sri Lanka). PubMed, Excerpta Medica Database (EMBASE), and CINAHL databases were systematically searched for observational (cross-sectional, case–control and cohort) studies that reported prevalence of diabetes in TB patients and published between 1 January 1980 and 30 July 2020. A random-effect model for computing the pooled prevalence of diabetes and a fixed-effect model for assessing its impact on TB treatment were used. The review was registered with PROSPERO number CRD42020167896. Of the 3463 identified studies, a total of 74 studies (47 studies from India, 10 from Pakistan, four from Nepal and two from both Bangladesh and Sri-Lanka) were included in this systematic review: 65 studies for the prevalence of diabetes among TB patients and nine studies for the impact of diabetes on TB treatment outcomes. The pooled prevalence of diabetes in TB patients was 21% (95% CI 18.0, 23.0; I2 98.3%), varying from 11% in Bangladesh to 24% in Sri-Lanka. The prevalence was higher in studies having a sample size less than 300 (23%, 95% CI 18.0, 27.0), studies conducted in adults (21%, 95% CI 18.0, 23.0) and countries with high TB burden (21%, 95% CI 19.0, 24.0). Publication bias was detected based on the graphic asymmetry of the funnel plot and Egger’s test (p < 0.001). Compared with non-diabetic TB patients, patients with TB and diabetes were associated with higher odds of mortality (Odds Ratio (OR) 1.7; 95% CI 1.2, 2.51; I2 19.4%) and treatment failure (OR 1.7; 95% CI 1.1, 2.4; I2 49.6%), but not associated with Multi-drug resistant TB (OR 1.0; 95% CI 0.6, 1.7; I2 40.7%). This study found a high burden of diabetes among TB patients in South Asia. Patients with TB-diabetes were at higher risk of treatment failure and mortality compared to TB alone. Screening for diabetes among TB patients along with planning and implementation of preventive and curative strategies for both TB and diabetes are urgently needed.

Transient Impact of Dysglycemia on Sputum Conversion among Smear-Positive Tuberculosis Patients in a Tertiary Care Facility in Ghana

“…6,[9][10][11] The relationship between rates of sputum conversion among TB patients with diabetes or dysglycemia appears inconsistent. 9,[12][13][14][15][16] Some studies have suggested a reduced rate at 2 months (end of the intensive phase) and 6 months (end of the treatment) 9,12 while others have shown no relationship between diabetes and sputum conversion rate at the end of the secondmonth. 14,17 More data are needed to help ascertain the impact of dysglycemia on the sputum conversion rate among TB patients.…”

Characteristics and Research Waste Among Randomized Clinical Trials in Gastric Cancer

“…Results from previous studies on the cutoff value for sample size were not uniform, and there is no JAMA Network Open | Gastroenterology and Hepatology specific definition for this value. 7,[11][12][13][14][15][16] In this study, we predefined RCTs with sample sizes smaller than the smallest 25% samples as small-sample RCTs. Because the incidence of GC is highly variable by region and culture, with higher incidence rates overall in Asian countries, we classified RCTs into Asian and non-Asian trials based on the location of the principal investigator (PI).…”

The Co-management of Tuberculosis-diabetes Co-morbidities in Indonesia Under the National Tuberculosis Control Program: Results From a Retrospective Cohort Study From 2017-2019

“…[6,14] The WHO recommends a ve-point questionnaire on TB symptoms to screen for suspected TB cases before administering diagnostic tests such as sputum smear test, culture tests or X-rays. [15] Although recent studies on TB and DM in LMICs supported the need for DM screening among all TB patients or at least high-risk patients; [7,11,[16][17][18][19][20][21] studies on the feasibility and impact of TB screening among DM patients have showed mixed-results even in countries with a high TB burden like India. [22][23][24][25][26] Nevertheless, the WHO still recommends active screening of TB among DM patients in countries with high TB prevalence (over 100/100 000).…”

“…[6] A systematic review of studies in South Asia suggested that DM prevalence among TB patients is higher in countries with a high TB burden. [7] Moreover, TB patients with DM are more likely to have adverse treatment outcomes such as relapse or even death, and potentially show a higher risk of developing multi-drug resistant TB. [7][8][9] Uncontrolled diabetes (plasma HbA1C level ≥ 7.0%) has been identi ed in studies as a risk factor for poor TB treatment outcomes, or even treatment failure.…”

“…[7] Moreover, TB patients with DM are more likely to have adverse treatment outcomes such as relapse or even death, and potentially show a higher risk of developing multi-drug resistant TB. [7][8][9] Uncontrolled diabetes (plasma HbA1C level ≥ 7.0%) has been identi ed in studies as a risk factor for poor TB treatment outcomes, or even treatment failure. [10,11] In 2011, the World Health Organization (WHO) and the International Union against Tuberculosis and Lung Disease released the "Collaborative framework for care and control of tuberculosis and diabetes".…”