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

Tamuhla, Tsaone; Dave, Joel A.; Raubenheimer, Peter; Tiffin, Nicki

doi:10.1371/journal.pone.0251303

Cited by 9 publications

(6 citation statements)

References 56 publications

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“…[33] While our study population and objectives differed, our results that prior TB disease is not associated with dysglycemia at a population level are consistent with the results of this South African study. [33] Our results suggest that HIV may modify the relationship between prior TB and diabetes. Among men without HIV, dysglycemia was more prevalent in individuals with a history of TB.…”

Section: Plos Onesupporting

confidence: 88%

“…Within South Africa, Tamuhla et al used data from a longitudinal health system to assess the relationship between prior TB disease on hemoglobin A1c values among persons living with diabetes. [33] This retrospective study found no evidence that TB disease influences the trajectory of glycemic control among persons with known diabetes over five years. [33] While our study population and objectives differed, our results that prior TB disease is not associated with dysglycemia at a population level are consistent with the results of this South African study.…”

Section: Plos Onementioning

confidence: 68%

“…[33] This retrospective study found no evidence that TB disease influences the trajectory of glycemic control among persons with known diabetes over five years. [33] While our study population and objectives differed, our results that prior TB disease is not associated with dysglycemia at a population level are consistent with the results of this South African study. [33] Our results suggest that HIV may modify the relationship between prior TB and diabetes.…”

Section: Plos Onementioning

confidence: 68%

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Association between prior tuberculosis disease and dysglycemia within an HIV-endemic, rural South African population

Castle

Hoeppner²,

Magodoro³

et al. 2023

PLoS ONE

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Objective Tuberculosis (TB) may predispose individuals to the development of diabetes. Such a relationship could have an outsized impact in high-prevalence TB settings. However, few studies have explored this relationship in populations heavily burdened by diabetes and TB. Methods We analyzed data from a community-based population cohort that enrolled adults in rural South Africa. Individuals were considered to have prior TB if they self-reported a history of TB treatment. We fitted sex-specific logistic regression models, adjusted for potential clinical and demographic confounders, to estimate relationships between dysglycemia (HBA1c ≥6.5%) and prior TB. Propensity score-matched cohorts accounted for the differential age distributions between comparator groups. We examined the interactions between sex, prior TB, and HIV status. Results In the analytic cohort (n = 17,593), the prevalence of prior TB was 13.8% among men and 10.7% among women. Dysglycemia was found in 9.1% of the population, and HIV prevalence was 34.0%. We found no difference in dysglycemia prevalence by prior TB (men OR 0.96, 95% CI 0.60–1.56: women OR 1.05, 95% CI 0.79–1.39). However, there was a qualitative interaction by HIV serostatus, such that among men without HIV, those with a history of TB had a greater prevalence of dysglycemia than those without prior TB (10.1% vs. 4.6%, p = 0.0077). An inverse relationship was observed among men living with HIV (prior TB 3.3% vs. no TB 7.3%, p = 0.0073). Conclusions Treated TB disease was not associated with dysglycemia in an HIV-endemic, rural South African population. However, we found a significant interaction between prior TB and HIV status among men, suggesting distinct pathophysiological mechanisms between the two infections that may impact glucose metabolism. Longitudinal studies are needed to better establish a causal effect and underlying mechanisms related to resolved TB, HIV, and diabetes.

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Section: Plos Onesupporting

confidence: 88%

Section: Plos Onementioning

confidence: 68%

Section: Plos Onementioning

confidence: 68%

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Association between prior tuberculosis disease and dysglycemia within an HIV-endemic, rural South African population

Castle

Hoeppner²,

Magodoro³

et al. 2023

PLoS ONE

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“…Comorbidity of DM and HIV will likely become more prevalent as cohorts of people with HIV start to age in SSA. In addition, people with HIV have a higher risk of contracting DM, due to ART treatment [34]. Because this and former reviews could not draw strong conclusions on the presence and magnitude of effect‐modification by HIV, a key evidence gap remains whether HIV status modifies the association between DM and TB.…”

Section: Discussionmentioning

confidence: 99%

Tuberculosis risk among people with diabetes mellitus in Sub‐Saharan Africa: A systematic review

Obels

Ninsiima

Critchley

et al. 2022

Tropical Med Int Health

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Objectives People with diabetes mellitus (DM) have a higher tuberculosis (TB) risk, but the evidence from sub‐Saharan Africa (SSA) was scarce until recently and not included in earlier global summaries. Therefore, this systematic review aims to determine the risk of active TB disease among people with DM in SSA and whether HIV alters this association. Methods Medline, Embase, CINAHL, Web of Science, Global Health and African Index Medicus were searched between January 1980 and February 2021. Cohort, case‐control and cross‐sectional studies from SSA, which assessed the association between DM and active TB, were included if adjusted for age. Two researchers independently assessed titles, abstracts, full texts, extracted data and assessed the risk of bias. Estimates for the association between DM and TB were summarised using a random effects meta‐analysis. PROSPERO: CRD42021241743. Results Nine eligible studies were identified, which reported on 110,905 people from 5 countries. Individual study odds ratios (OR) of the TB–DM association ranged from 0.88 (95% CI 0.17–4.58) to 10.7 (95% CI 4.5–26). The pooled OR was 2.77 (95% CI 1.90–4.05). High heterogeneity was reduced in sensitivity analysis (from I2 = 57% to I2 = 6.9%), by excluding one study which ascertained DM by HbA1c. Risk of bias varied widely between studies, especially concerning the way in which DM status was determined. Conclusions There is a strong positive association between DM and active TB in SSA. More research is needed to determine whether HIV, a key risk factor for TB in SSA, modifies this relationship.

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“…(2) and, in collaboration with the Academy of Sciences of South Africa, for sub-Saharan Africa specifically (7). Priorities include research into the patterning, burden, and determinants of disease 'clusters'; (8)(9)(10)(11) improving prevention and treatment of multimorbidity; (12,13) and the development of upstream health systems interventions and care models to better respond to the needs of people living with multimorbidity (PLWMM). (14,15) With current concepts and models of multimorbidity disproportionately based on biomedical research in the global North, (15) these initiatives emphasise the need for a more equitable, Southern-led response, facilitated by changes within the research ecosystem (2,7).…”

Section: Introductionmentioning

confidence: 99%

Interdisciplinary perspectives on multimorbidity in Africa: developing an expanded conceptual model

Dixon,

Morton,

Nkhata

et al. 2023

Preprint

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Multimorbidity is an emerging challenge for healthcare systems globally. It is commonly defined as the co-occurrence of two or more chronic conditions in one person, but the suitability and utility of this concept beyond high-income settings is uncertain. This article presents the findings from an interdisciplinary research initiative that drew together 60 academic and applied partners working in 10 African countries to critically consider existing concepts and definitions of multimorbidity, to evaluate their utility and limitations, and to co-develop an context-sensitive, interdisciplinary conceptual framing. This iterative process was guided by the principles of grounded theory and involved focus- and whole-group discussions during a three-day concept-building workshop, thematic coding of workshop discussions, and further post-workshop iterative development and refinement. The three main thematic domains that emerged from workshop discussions were: the disease-centricity of current concepts and definitions; the need to foreground what matters to people living with multimorbidity (PLWMM), families, and other stakeholders; and the need for conceptual breadth and flexibility to accommodate the contributions of multiple disciplinary perspectives and heterogeneity within and between different African countries. These themes fed into the development of an expanded conceptual model that centres the catastrophic impacts multimorbidity often has for PLWMM, their families and support structures, for service providers, and for resource-constrained healthcare systems.

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

Cited by 9 publications

References 56 publications

Association between prior tuberculosis disease and dysglycemia within an HIV-endemic, rural South African population

Association between prior tuberculosis disease and dysglycemia within an HIV-endemic, rural South African population

Tuberculosis risk among people with diabetes mellitus in Sub‐Saharan Africa: A systematic review

Interdisciplinary perspectives on multimorbidity in Africa: developing an expanded conceptual model

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