Is resistance to anti-tuberculosis drugs associated with type 2 diabetes mellitus? A register review in Beijing, China

Abstract

BackgroundChina has a high burden of drug-resistant tuberculosis (TB) and diabetes mellitus (DM).ObjectiveThe objectives of this study were to determine the following in patients with culture-confirmed TB: 1) demographic characteristics and disease patterns in relation to the presence or absence of type 2 diabetes and 2) presence or absence of drug resistance to isoniazid (INH), rifampicin (RMP) or both in relation to duration of diabetes and control of diabetes.DesignThis is a cross-sectional and retrospective study involving record reviews.ResultsThere were 621 patients with culture-positive TB, of whom 187 (30%) had previously known or new type 2 diabetes. In those with diabetes, there was a significantly higher proportion of males, persons aged ≥35 years and patients registered with new TB (p<0.05). Prevalence of multidrug-resistant TB (MDR-TB) was 6.2% in new patients (N=422) and 62.3% in previously treated patients (N=199), with no significant differences between those with and without diabetes. In patients with diabetes, there was no association of drug resistance with diabetes duration or disease control [assessed by fasting blood glucose (FBG) at 1 week].ConclusionA high proportion of patients with TB in a tertiary health facility, Beijing, China, had diabetes, but there was no association between type 2 diabetes and drug-resistant TB. Further prospective studies are needed to confirm these findings.

Primary multidrug-resistant tuberculosis versus drug-sensitive tuberculosis in non-HIV-infected patients: Comparisons of CT findings

“…The proportion of patients with diabetes did not differ significantly between the two groups, consistent with reports suggesting that diabetes mellitus is not associated with drug-resistant TB[13, 14]. …”

Effects of diabetes mellitus on the clinical presentation and treatment response in tuberculosis

“…Despite the large sample size of the current study, no significant association was observed between DM and isoniazid, rifampicin or multidrug resistance (Tables ,). While two previous studies in Mexico and another study in India showed significant association between DM and multidrug‐resistant TB, such association was not observed in Peru or China . Ethnic differences, differing epidemiological profiles and different clinical practices might all have contributed to the observed variations.…”

“…While two previous studies in Mexico 26,27 and another study in India 28 showed significant association between DM and multidrug-resistant TB, such association was not observed in Peru 29 or China. 30 Ethnic differences, differing epidemiological profiles and , permanent residency, actively employed, homeless/overcrowded, alcohol dependence, drug abuse, smoking status, HIV, previous TB treatment, extent of pulmonary involvement (no lung lesion, lung lesion ≤ right upper lobe, lung lesion > right upper lobe), cavity and sputum status (smear and culture negative, culture positive only and smear positive) at the baseline; for the overall cohort, also adjusted for use of HRZ-containing standard regimen.…”

Tuberculosis-associated mortality in Shanghai, China: a longitudinal study

“…This is lower than previously reported for people with tuberculosis in India (6.1), 17 the Netherlands (8.3), 18 and Ethiopia (10.0), 19 at least in part because there is less co-infection with HIV in China. 20 Men had higher mortality rates than women, which may be because of sex differences in clinical characteristics (smear results, cavitation, prevalence of comorbidities and MDR-tuberculosis), 21 a higher likelihood of noncompliance with treatment, or the presence of additional risk factors such as smoking. 6 , 17 , 19 , 22 Participants with disseminated pulmonary disease, smear-positive disease or MDR-tuberculosis had higher SMRs than those without these characteristics.…”