Diabetes Mellitus Among Pulmonary Tuberculosis Patients From 4 Tuberculosis-endemic Countries: The TANDEM Study

Ugarte-Gil, César; Alisjahbana, Bachti; Ronacher, Katharina; Riza, Anca Lelia; Koesoemadinata, Raspati C; Malherbe, Stephanus T.; Cioboată, Ramona; Llontop, Juan Carlos; Kleynhans, Léanie; López, Sonia; Santoso, Prayudi; Marius, Ciontea; Villaizan, Katerine; Ruslami, Rovina; Walzl, Gerhard; Panduru, Nicolae Mircea; Dockrell, Hazel M.; Hill, Philip C.; Allister, Susan Mc; Pearson, Fiona; Moore, David; Critchley, Julia; Crevel, Reinout van

doi:10.1093/cid/ciz284

Cited by 82 publications

(100 citation statements)

References 32 publications

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“…The risk of diabetes was the greatest in the middle-aged group (40-65 years). However, unlike recent data from a multi-country study investigating diabetes in TB (the TANDEM study), we did not observe an association between diabetes and previous TB or with smear positive cases 31 . The distribution of HbA1c values for our diabetic population (new and previously diagnosed cases) was also similar to that from the Indonesian TANDEM study population, in whom a single point of care (POC) HbA1c test was shown to have high sensitivity and specificity to detect new diabetes cases, adding confidence to our diagnoses of diabetes using this single POC measurement 41 .…”

Section: Discussioncontrasting

confidence: 99%

“…The prevalence of diabetes, at 9.1%, with more than 50% of diabetes cases newly diagnosed by the study screening was higher than current national estimates for the Philippines general population (6.1%,WHO 2016) 29 . but lower than the 14.1% reported in 634 urban HIV-negative Indonesians with newly diagnosed pulmonary TB, systematically assessed for diabetes by fasting blood glucose 30 and more recently of 19.7% in the Indonesian participants of the multi-country "TANDEM study" 31 . Previous limited reports in the Philippines include a diabetes prevalence of 18% in pulmonary TB patients in Quezon City (N = 38) 32 , and 17.7% in a cohort of acutely unwell admissions to a TB ward in Manila (N = 348) 33 .…”

Section: Discussionmentioning

confidence: 83%

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Patterns and predictors of co-morbidities in Tuberculosis: A cross-sectional study in the Philippines

White

Edwards

Lee

et al. 2020

Sci Rep

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Diabetes and undernutrition are common risk factors for tB, associated with poor treatment outcomes and exacerbated by tB. We aimed to assess non-communicable multimorbidity (co-occurrence of two or more medical conditions) in filipino tB outpatients, focusing on malnutrition and diabetes. in a crosssectional study, 637 adults (70% male) from clinics in urban Metro Manila (N = 338) and rural Negros occidental (n = 299) were enrolled. Diabetes was defined as HbA1c of ≥6.5% and/or current diabetes medication. Study-specific HIV screening was conducted. The prevalence of diabetes was 9.2% (54/589, 95%CI: 7.0-11.8%) with 52% newly diagnosed. Moderate/severe undernutrition (body mass index (BMi) <17 kg/ 2) was 20.5% (130/634, 95%CI: 17.4-23.9%). Forty percent of participants had at least one co-morbidity (diabetes, moderate/severe undernutrition or moderate/severe anaemia (haemoglobin <11 g/dL)). HIV infection (24.4%, 74/303) was not associated with other co-morbidities (but high refusal in rural clinics). central obesity assessed by waist-to-hip ratio was more strongly associated with diabetes (Adjusted odds Ratio (AoR) = 6.16, 95%CI: 3.15-12.0) than BMI. Undernutrition was less common in men (AoR = 0.44, 95%CI: 0.28-0.70), and associated with previous history of TB (AoR = 1.97, 95%CI: 1.28-3.04) and recent reduced food intake. The prevalence of multimorbidity was high demonstrating a significant unmet need. HIV was not a risk factor for increased non-communicable multimorbidity.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 83%

Patterns and predictors of co-morbidities in Tuberculosis: A cross-sectional study in the Philippines

White

Edwards

Lee

et al. 2020

Sci Rep

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“…A biomarker study to examine the influence of helminth co-infection in leprosy patients is currently ongoing. Moreover, the influence on biomarker levels of co-morbidities, such as diabetes mellitus which is known to increase the risk of active TB ( 42 ), on the disease outcome should be further studied. Another issue impeding straightforward implementation of biomarkers is that inflammatory markers are not disease-specific.…”

Section: Discussionmentioning

confidence: 99%

Household Contacts of Leprosy Patients in Endemic Areas Display a Specific Innate Immunity Profile

et al. 2020

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Leprosy is a chronic infectious disease, caused by Mycobacterium leprae, that can lead to severe lifelong disabilities. The transmission of M. leprae is continuously ongoing as witnessed by the stable new case detection rate. The majority of exposed individuals does, however, not develop leprosy and is protected from infection by innate immune mechanisms. In this study the relation between innate immune markers and M. leprae infection as well as the occurrence of leprosy was studied in household contacts (HCs) of leprosy patients with high bacillary loads. Serum proteins associated with innate immunity (ApoA1, CCL4, CRP, IL-1Ra, IL-6, IP-10, and S100A12) were determined by lateral flow assays (LFAs) in conjunction with the presence of M. leprae DNA in nasal swabs (NS) and/or slit-skin smears (SSS). The HCs displayed ApoA1 and S100A12 levels similar to paucibacillary patients and could be differentiated from endemic controls based on the levels of these markers. In the 31 households included the number (percentage) of HCs that were concomitantly diagnosed with leprosy, or tested positive for M. leprae DNA in NS and SSS, was not equally divided. Specifically, households where M. leprae infection and leprosy disease was not observed amongst members of the household were characterized by higher S100A12 and lower CCL4 levels in whole blood assays of HCs in response to M. leprae. Lateral flow assays provide a convenient diagnostic tool to quantitatively measure markers of the innate immune response and thereby detect individuals which are likely infected with M. leprae and at risk of developing disease or transmitting bacteria. Low complexity diagnostic tests measuring innate immunity markers can therefore be applied to help identify who should be targeted for prophylactic treatment.

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“…Similarly, logistic regression models were applied to explore the risk factors of primary drug resistance among TB-DM cases as well. Covariates adjusted for multivariable models were chosen based on previous studies 4,11. Factors including age, sex (male or female), BMI, drinking (yes/no), smoking (yes/no), cavity (yes/no)m and hypertension (yes/no) were adjusted for multivariable logistic regression model.…”

Section: Methodsmentioning

confidence: 99%

<p>Primary drug resistance among tuberculosis patients with diabetes mellitus: a retrospective study among 7223 cases in China</p>

Song

Shao

Liu

et al. 2019

IDR

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Background Given the high burden of tuberculosis (TB) and diabetes mellitus (DM) in China and the worse outcome of TB-DM cases (refers to TB patients with diabetes), and drug-resistant tuberculosis cases (DR-TB), it is of great significance to explore the association between diabetes and primary DR-TB for TB elimination target in China. We assessed the clinical characteristics, drug-resistance profile, and increased risk of resistance among TB-DM patients across China from 2004 to 2017. Method 7223 cases with drug-susceptibility data were collected from Shandong, China. Categorical baseline characteristics of new TB cases were compared by DM status using Fisher’s exact or Pearson Chi-square test. Univariable analysis and multivariable logistic models were used to estimate the association between diabetes and different drug-resistance profiles and the risk factors of primary drug resistance among TB-DM cases. Result Of 7223 newly diagnosed TB patients, 426 (5.90%) were TB-DM cases. TB-DM csaes were more likely to be older，accompanied by higher body mass index (BMI) and hypertension than TB-no DM cases (refers to TB patients without diabetes). The rates of DR-TB (21.83% vs 16.96%), polydrug resistant TB (PDR-TB, 6.10% vs 3.80%), isoniazid (INH)+streptomycin (SM)-resistant TB (4.93% vs 3.13%), and SM-resistant TB (16.20% vs 11.7%) among TB-DM group were higher than TB-no DM group, P <0.05. DM was significantly associated with any DR-TB (adjusted (aOR):1.30; 95% CI, 1.02–1.65), SM-related resistance (aOR: 1.43; 95% CI, 1.08–1.88), PDR-TB (OR: 1.57; 95% CI, 1.04–2.36; aOR: 1.59; 95% CI, 1.04–2.44), compared with pan-susceptible TB patients ( P <0.05). Conclusion Our study indicated that TB-DM groups had a higher proportion of drug resistance than TB groups, and diabetes was identified as a risk factor of total DR, PDR, SM resistance and INH+SM resistance among newly diagnosed TB cases. Good management of diabetes and TB infection screening program among DM patients might be necessary for improving TB control in China.

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Diabetes Mellitus Among Pulmonary Tuberculosis Patients From 4 Tuberculosis-endemic Countries: The TANDEM Study

Cited by 82 publications

References 32 publications

Patterns and predictors of co-morbidities in Tuberculosis: A cross-sectional study in the Philippines

Patterns and predictors of co-morbidities in Tuberculosis: A cross-sectional study in the Philippines

Household Contacts of Leprosy Patients in Endemic Areas Display a Specific Innate Immunity Profile

<p>Primary drug resistance among tuberculosis patients with diabetes mellitus: a retrospective study among 7223 cases in China</p>

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