Prevalence of Diabetes and Pre-Diabetes and Associated Risk Factors among Tuberculosis Patients in India

Abstract

BackgroundDiabetes mellitus (DM) is recognised as an important risk factor to tuberculosis (TB). India has high TB burden, along with rising DM prevalence. There are inadequate data on prevalence of DM and pre-diabetes among TB cases in India. Aim was to determine diabetes prevalence among a cohort of TB cases registered under Revised National Tuberculosis Control Program in selected TB units in Tamil Nadu, India, and assess pattern of diabetes management amongst known cases.Methods827 among the eligible patients (n = 904) underwent HbA1c and anthropometric measurements. OGTT was done for patients without previous history of DM and diagnosis was based on WHO criteria. Details of current treatment regimen of TB and DM and DM complications, if any, were recorded. A pretested questionnaire was used to collect information on sociodemographics, habitual risk factors, and type of TB.FindingsDM prevalence was 25.3% (95% CI 22.6–28.5) and that of pre-diabetes 24.5% (95% CI 20.4–27.6). Risk factors associated with DM among TB patients were age (31–35, 36–40, 41–45, 46–50, >50 years vs <30 years) [OR (95% CI) 6.75 (2.36–19.3); 10.46 (3.95–27.7); 18.63 (6.58–52.7); 11.05 (4.31–28.4); 24.7 (9.73–62.7) (p<0.001)], positive family history of DM [3.08 (1.73–5.5) (p<0.001)], sedentary occupation [1.69 (1.10–2.59) (p = 0.016)], and BMI (18.5–22.9, 23–24.9 and ≥25 kg/m2 vs <18.5 kg/m2) [2.03 (1.32–3.12) (p = 0.001); 0.87 (0.31–2.43) (p = 0.78); 1.44 (0.54–3.8) (p = 0.47)]; for pre-diabetes, risk factors were age (36–40, 41–45, 46–50, >50 years vs <30 years) [2.24 (1.1–4.55) (p = 0.026); 6.96 (3.3–14.7); 3.44 (1.83–6.48); 4.3 (2.25–8.2) (p<0.001)], waist circumference [<90 vs. ≥90 cm (men), <80 vs. ≥80 cm (women)] [3.05 (1.35–6.9) (p = 0.007)], smoking [1.92 (1.12–3.28) (p = 0.017)] and monthly income (5000–10,000 INR vs <5000 INR) [0.59 (0.37–0.94) (p = 0.026)]. DM risk was higher among pulmonary TB [3.06 (1.69–5.52) (p<0.001)], especially sputum positive, than non-pulmonary TB.InterpretationNearly 50% of TB patients had either diabetes or pre-diabetes.

Is screening for diabetes among tuberculosis patients feasible at the field level?

“…12 Previous studies from other South Indian states, such as Kerala and Tamil Nadu, reported a prevalence of 44% and 25% respectively. 4,5 As has been reported in earlier studies, patients aged >40 years and those with smearpositive pulmonary TB had a higher prevalence of DM. 4 Nearly 44% of the TB patients were smokers, and DM prevalence was higher among smokers than non-smokers.…”

“…4,5 The actual prevalence could be much higher, as we used FBG to diagnose DM and it is well known that FBG is not as sensitive as the 75 g oral glucose tolerance test (OGTT) and that it may miss cases of impaired glucose tolerance. 11 A hospital-based study conducted in Karnataka State reported a DM prevalence of 30% among TB patients.…”

Study on Relationships Between Dietary Mineral Intakes and Blood Pressure and Blood Lipid in TB patients

“…TB was a wasting disease, and nutritional consumption was a major feature of patients with TB [18]. The study found that the energy and nutrients intake were generally low, and the intake of energy, vitamins and minerals were closely related to the occurrence and development of the disease.…”

‘Diabetes and Tuberculosis’ – A Co-Epidemic of Public Health Importance in the Developing World

“…The high prevalence of diabetes among patients with TB has also been shown from the states of Tamil Nadu and Kerala. Viswanathan et al 9 in their cross-sectional study in TB units in South India, reported the prevalence of diabetes and pre-DM among TB patients to be 25.3% and 24.5% respectively, almost 50% of TB patients had some form of hyperglycaemia. Balakrishnan et al 10 using glycosylated haemoglobin (HbA1c) as a diagnostic tool, reported DM prevalence of 44% among TB patients 10 .…”