Diabetes mellitus is associated with cavities, smear grade, and multidrug-resistant tuberculosis in Georgia

Abstract

SUMMARY Setting National tuberculosis (TB) treatment facility, country of Georgia. Objective To determine the prevalence of diabetes mellitus (DM) and pre-DM among patients with TB using glycosylated-hemoglobin (HbA1c), and to estimate the association between DM and clinical characteristics and response to TB therapy. Design A cohort study was conducted (2011–2014) at the National Center for TB and Lung Disease in Tbilisi. Patients ≥35 years with pulmonary TB were included. HbA1c was used to define DM (≥6.5%), pre-DM (≥5.7%–6.4%), and no DM (<5.7%). Interviews and medical chart abstraction were performed. Regression analyses estimated associations between DM and 1) baseline TB characteristics and 2) TB treatment outcomes. Results A total of 318 newly diagnosed patients with TB were enrolled. Prevalence of DM was 11.6% and pre-DM prevalence was 16.4%. In multivariable analyses, patients with TB-DM had more cavitation (aOR 2.26), higher smear (aOR 2.37), and more MDR-TB (aOR 2.27) compared to patients without DM. Risk of poor TB treatment outcome was similar among patients with and without DM (28.1% vs. 23.6%). Conclusion Diabetes and pre-DM were common among adults with newly diagnosed pulmonary TB in Tbilisi, Georgia and DM was associated with more clinical symptoms at presentation including MDR-TB.

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.…”

“…The lack of significant association observed between DM and DR-TB treatment outcome is consistent with findings from studies conducted in other countries, such as Georgia, Peru, Mexico and China. [11][12][13][14] However, studies in South Korea, Taiwan and Brazil have reported an association of DM with unfavourable outcomes. [7][8][9] These studies also report that unfavourable outcomes were significantly associated with poor glycaemic controls and other comorbidities caused by DM, such as chronic renal diseases, cardiovascular diseases and cerebrovascular diseases in patients with DM.…”

Tuberculosis and Diabetes Mellitus- Not a Sweet Association!

“…Matthew J Magee et al shows that patients with TB and DM were more likely to have a higher AFB smear grade (aOR 2.37, 95% CI 1.14 -4.94). [11] Dooley, Kelly E et al shows higher sputum positivity in patients with DM. [12] Park SW et al shows a higher positive smear rates (p < 0.001) among diabetics as compared with nondiabetics.…”

What Factors May Influence Epidemiological Situation of Tuberculosis in Poland and in the World?

“…It is known that TB occurs 3 times more often in patients with DM than in others [42,43]. The risk is greater if DM is not well controlled.…”

“…Thus some immunosuppression linked with DM is observed [44] and the delay in diagnosis is noted [45]. This is probably the cause of more advanced pulmonary disease presenting with cavities in newly recognised patients with tuberculosis and DM, comparing to those without DM [42,46]. DM is not only an important risk factor for tuberculosis but may also affect the disease course and treatment response.…”