High prevalence of undiagnosed diabetes among tuberculosis patients in peripheral health facilities in Kerala

Nair, Sanjeev; Kumari, Ajitha; Subramonianpillai, J.; Shabna, D. S.; Kumar, Sunil; Balakrishnan, Shibu; Naik, Balaji; Kumar, Ajay M. V.; Isaakidis, Petros; Satyanarayana, Srinath

doi:10.5588/pha.13.0037

Cited by 36 publications

(27 citation statements)

References 7 publications

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“…32,[36][37][38][39] Our study did not find associations with BMI and type of TB. Although older age was associated with an increased chance of DM, the rate in the younger age group was still above that in the general population.…”

Section: Public Health Actioncontrasting

confidence: 59%

Diabetes and pre-diabetes in tuberculosis patients in western Kenya using point-of-care glycated haemoglobin

Owiti

Keter

Harries

et al. 2017

public health action

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Section: Public Health Actioncontrasting

confidence: 59%

Diabetes and pre-diabetes in tuberculosis patients in western Kenya using point-of-care glycated haemoglobin

Owiti

Keter

Harries

et al. 2017

public health action

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“…Despite these limitations, our results are generalizable to other TB populations in India, particularly those with a similar age range. 11,13,14 …”

Section: Discussionmentioning

confidence: 99%

“…9 Data from India indicate a wide range of DM prevalence (6.5–33%) among TB cases; all of these estimates are much higher than for the general population. 9–14 More recently, a report from South India showed that over 75% of TB cases had dysglycemia, with 54% meeting the criteria for DM. 15 As the diet and genetics of the people and the epidemiology of dysglycemia are likely to vary in different parts of India, region-specific data are needed, particularly for Western India, where data are limited.…”

mentioning

confidence: 99%

Prevalence of dysglycemia and clinical presentation of pulmonary tuberculosis in Western India

Mave

Meshram

Lokhande

et al. 2017

int j tuberc lung dis

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SUMMARY SETTING: Pune, India. OBJECTIVES: To estimate the prevalence and risk factors of pre-diabetes mellitus (DM) and DM, and its associations with the clinical presentation of tuberculosis (TB). DESIGN: Screening for DM was conducted among adults (age ⩾ 18 years) with confirmed TB between December 2013 and January 2017. We used multinomial regression to evaluate the risk factors for pre-DM (glycated hemoglobin [HbA1c] ⩾ 5.7–6.5% or fasting glucose 100–125 mg/dl) and DM (HbA1c ⩾ 6.5% or fasting glucose ⩾ 126 mg/dl or random blood glucose > 200 mg/dl or self-reported DM history/treatment) and the association of dysglycemia with the severity of TB disease. RESULTS: Among 1793 participants screened, 890 (50%) had microbiologically confirmed TB. Of these, 33% had pre-DM and 18% had DM; 41% were newly diagnosed. The median HbA1c level among newly diagnosed DM was 7.0% vs. 10.3% among known DM (P < 0.001). DM (adjusted OR [aOR] 4.94, 95%CI 2.33–10.48) and each per cent increase in HbA1c (aOR 1.42, 95%CI 1.01–2.01) was associated with >1+smear grade or ⩽9 days to TB detection. CONCLUSION: Over half of newly diagnosed TB patients had DM or pre-DM. DM and increasing dysglycemia was associated with higher bacterial burden at TB diagnosis, potentially indicating a higher risk of TB transmission to close contacts.

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“…3 Studies conducted in India have reported that many TB patients had had undiagnosed DM. 16,25 In a recent prospective study in Kiribati, where all TB patients aged 18 years were tested for DM at the time of TB diagnosis, 55% were newly diagnosed with DM and had not known their DM status before attending the TB clinic.…”

Section: Public Health Action Tb and Diabetes In Fiji 162mentioning

confidence: 99%

Sputum smear conversion and treatment outcomes for tuberculosis patients with and without diabetes in Fiji

Prasad

Gounder

Varman

et al. 2014

public health action

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Fiji is a low tuberculosis (TB) burden country, with a TB incidence rate of 24 cases per 100 000 population and a high treatment success rate of 90% (2012 data). 1 However, diabetes mellitus (DM) is very common in Fiji, and its prevalence is thought to be increasing. The STEPwise approach to Surveillance (STEPs) study conducted in 2002 reported a population prevalence of 16% for DM. 2 A more recent estimate, using a different methodology, gave a DM prevalence among adults in Fiji of 10.9%, with impaired glucose tolerance in a further 11.0%. 3 This remarkably high prevalence of DM is a matter of concern for TB control in Fiji. Published data from other settings have concluded that people with DM have a significantly increased risk of developing TB and worse treatment outcomes, with a higher risk of mortality and treatment failure during anti-tuberculosis treatment than among patients without DM. [4][5][6] In response to this evidence, the Fiji National Tuberculosis Programme (NTP) introduced random blood glucose (RBG) testing to screen for DM in all registered TB patients in 2011. 7 A recent local study reported DM in 14% of TB patients in Fiji. 8 It has been noted by local clinical and public health staff that sputum smear-positive TB patients with DM take longer to convert to smear-negative than TB patients without DM, and that they thus require longer periods of hospitalisation. However, this observation has not been verified empirically, and there are no published data from Fiji reporting sputum smear conversion or treatment response in TB patients with and without DM.In the present study, we aimed to evaluate treatment outcomes and sputum smear conversion in TB patients with DM and compare these indicators in TB patients without DM. METHODS Study designThis was a retrospective descriptive study using routinely collected data from the TB register and in-patient folders from three TB treatment hospitals in Fiji. SettingFiji is an island nation, located in the Pacific Ocean, classified as an upper middle-income economy. 9 It comprises 332 islands, of which 110 are inhabited. The population of 837 231 comprises 56.8% i-Taukei (indigenous Fijians) and 37.5% Fijians of Indian descent; the remaining 5.7% are from other ethnic backgrounds. 10 The Fiji NTP is largely funded by the government, and TB diagnosis and treatment are provided free of charge. Three government hospitals provide TB services for the entire country; the private sector is not involved in TB control. All patients diagnosed with TB are registered as TB cases and treated at one of the three TB treatment centres. The majority of TB patients are admitted for the 2-month intensive phase of treatment, during which they receive anti-tuberculosis treatment and clinical follow-up. Clinical evaluation on admission routinely includes a full medical history and RBG screening if the patient is not known to have DM. If RBG is 6.1 mmol/l, fasting blood glucose (FBG) is tested. If the FBG is 7 mmol/l, 8 patients are diagnosed as having DM and referred to a ph...

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High prevalence of undiagnosed diabetes among tuberculosis patients in peripheral health facilities in Kerala

Cited by 36 publications

References 7 publications

Diabetes and pre-diabetes in tuberculosis patients in western Kenya using point-of-care glycated haemoglobin

Diabetes and pre-diabetes in tuberculosis patients in western Kenya using point-of-care glycated haemoglobin

Prevalence of dysglycemia and clinical presentation of pulmonary tuberculosis in Western India

Sputum smear conversion and treatment outcomes for tuberculosis patients with and without diabetes in Fiji

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