Disease characteristics and treatment of patients with diabetes mellitus attending government health services in Indonesia, Peru, Romania and South Africa

Soetedjo, Nanny Natalia Mulyani; McAllister, Susan; Ugarte-Gil, César; Firănescu, Adela Gabriela; Ronacher, Katharina; Alisjahbana, Bachti; Costache, Anca L; Zubiate, Carlos; Malherbe, Stephanus T.; Koesoemadinata, Raspati C; Laurence, Yoko; Pearson, Fiona; Kerry-Barnard, Sarah; Ruslami, Rovina; Moore, David; Ioana, Mihai; Kleynhans, Léanie; Permana, Hikmat; Hill, Philip C.; Moța, Maria; Walzl, Gerhard; Dockrell, Hazel M.; Critchley, Julia; Crevel, Reinout van

doi:10.1111/tmi.13137

Cited by 19 publications

(13 citation statements)

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“…Also, hypertension was common but often untreated. These figures are in line with significant gaps in management of DM in general that we found in these same settings [36].…”

Section: Discussionsupporting

confidence: 88%

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

Ugarte-Gil

Alisjahbana

Ronacher

et al. 2019

Clinical Infectious Diseases

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BackgroundDiabetes mellitus (DM) increases active tuberculosis (TB) risk and worsens TB outcomes, jeopardizing TB control especially in TB-endemic countries with rising DM prevalence rates. We assessed DM status and clinical correlates in TB patients across settings in Indonesia, Peru, Romania, and South Africa.MethodsAge-adjusted DM prevalence was estimated using laboratory glycated hemoglobin (HbA1c) or fasting plasma glucose in TB patients. Detailed and standardized sociodemographic, anthropometric, and clinical measurements were made. Characteristics of TB patients with or without DM were compared using multilevel mixed-effect regression models with robust standard errors.ResultsOf 2185 TB patients (median age 36.6 years, 61.2% male, 3.8% human immunodeficiency virus–infected), 12.5% (267/2128) had DM, one third of whom were newly diagnosed. Age-standardized DM prevalence ranged from 10.9% (South Africa) to 19.7% (Indonesia). Median HbA1c in TB–DM patients ranged from 7.4% (Romania) to 11.3% (Indonesia). Compared to those without DM, TB–DM patients were older and had a higher body mass index (BMI) (P value < .05). Compared to those with newly diagnosed DM, TB patients with diagnosed DM had higher BMI and HbA1c, less severe TB, and more frequent comorbidities, DM complications, and hypertension (P value < .05).ConclusionsWe show that DM prevalence and clinical characteristics of TB–DM vary across settings. Diabetes is primarily known but untreated, hyperglycemia is often severe, and many patients with TB–DM have significant cardiovascular disease risk and severe TB. This underlines the need to improve strategies for better clinical management of combined TB and DM.

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“…Also, hypertension was common but often untreated. These figures are in line with significant gaps in management of DM in general that we found in these same settings [36].…”

Section: Discussionsupporting

confidence: 88%

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

Ugarte-Gil

Alisjahbana

Ronacher

et al. 2019

Clinical Infectious Diseases

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“…However, diabetes prevention and improving diabetes management in low-income settings have both proved very challenging. The latter has substantial resource implications and requirements for training many health care providers, given the large numbers of patients with poorly managed diabetes [82,84]. A third TB prevention strategy could be latent tuberculosis infection (LTBI) screening and preventive therapy in people with diabetes; modern treatment regimens (e.g., 3HP) are shorter and simpler than previously used 6-9 months of isoniazid, making this approach more feasible.…”

Section: Control Of Diabetes-associated Tuberculosis At a Population Levelmentioning

confidence: 99%

The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice

Crevel

Critchley

2021

TropicalMed

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Diabetes Mellitus increases the risk of developing Tuberculosis (TB) disease by about three times; it also doubles the risk of death during TB treatment and other poor TB treatment outcomes. Diabetes may increase the risk of latent infection with Mycobacterium tuberculosis (LTBI), but the magnitude of this effect is less clear. Whilst this syndemic has received considerable attention, most of the published research has focussed on screening for undiagnosed diabetes in TB patients or observational follow-up of TB treatment outcomes by diabetes status. There are thus substantial research and policy gaps, particularly with regard to prevention of TB disease in people with diabetes and management of patients with TB–diabetes, both during TB treatment and after successful completion of TB treatment, when they likely remain at high risk of TB recurrence, mortality from TB and cardiovascular disease. Potential strategies to prevent development of TB disease might include targeted vaccination programmes, screening for LTBI and preventive therapy among diabetes patients or, perhaps ideally, improved diabetes management and prevention. The cost-effectiveness of each of these, and in particular how each strategy might compare with targeted TB prevention among other population groups at higher risk of developing TB disease, is also unknown. Despite research gaps, clinicians urgently need practical management advice and more research evidence on the choice and dose of different anti-diabetes medication and effective medical therapies to reduce cardiovascular risks (statins, anti-hypertensives and aspirin). Substantial health system strengthening and integration may be needed to prevent these at risk patients being lost to care at the end of TB treatment.

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“…Socio-economic status and the level of education are perhaps the factors most correlated with the incidence of DM in South Africa. A recent epidemiological study reported that economic status was the most important factor in the development of DM (Soetedjo et al, 2018 A correlation between ethnicity and the prevalence of DM is also evident. A higher than average incidence of morbidity and mortality from DM has been reported in black South African populations compared with other South African ethnic groups (Erasto et al, 2005).…”

Section: An Overview Of Diabetes Mellitus In South Africamentioning

confidence: 99%

The use of South African botanical species for the control of blood sugar

Cock

Ndlovu

Vuuren

2021

Journal of Ethnopharmacology

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Ethnopharmacological relevance: Diabetes mellitus (DM) is one of the most prevalent diseases globally and is of considerable concern to global health. Approximately 425 million people are estimated to have DM globally and this is predicted to increase to >642 million by 2040. Whilst the prevalence of DM in South Africa is slightly lower than the global average, it is expected to rise rapidly in future years as more South Africans adopt a high calorie "Westernised" diet. Traditional medicines offer an alternative for the development of new medicines to treat DM and the usage of South African plants is relatively well documented. Aim of the study:To critically review the literature on the anti-diabetic properties of South African plants and to document plant species used for the treatment of DM. Thereafter, a thorough examination of the related research will highlight where research is lacking in the field.Materials and methods: A review of published ethnobotanical books, reviews and primary scientific studies was undertaken to identify plants used to treat DM in traditional South African healing systems and to identify gaps in the published research. The study was nonbiased, without taxonomic preference and included both native and introduced species. To be included, species must be recorded in the pharmacopeia of at least one South African ethnic group for the treatment of DM.Results: One hundred and thirty-seven species are recorded as therapies for DM, with leaves and roots most commonly used. The activity of only 43 of these species have been verified by rigorous testing, although relatively few studies have examined the mechanism of action. Conclusion:Despite relatively extensive ethnobotanical records and a diverse flora, the antidiabetic properties of South African medicinal plants is relatively poorly explored. The efficacy of most plants used traditionally to treat DM are yet to be verified and few mechanistic studies are available. Further research is required in this field.

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Disease characteristics and treatment of patients with diabetes mellitus attending government health services in Indonesia, Peru, Romania and South Africa

Cited by 19 publications

References 32 publications

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

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

The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice

The use of South African botanical species for the control of blood sugar

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