Prevalence of diabetes mellitus amongst hospitalized tuberculosis patients at an Indian tertiary care center: A descriptive analysis

Abstract

BackgroundIndia has a high prevalence of tuberculosis (TB) as well as diabetes mellitus (DM). DM is a chronic disease caused by deficiency of insulin production by the pancreas. The risk of TB amongst DM patients is three times higher than those without. The estimated national prevalence of DM is 7.3%. Despite the growing burden of DM, there are limited studies describing the prevalence of TB-DM in India.ObjectiveOur study estimated the prevalence of DM amongst adult hospitalized TB patients at Kasturba Hospital, Manipal and determined factors associated with the likelihood of DM-TB co-prevalence.MethodsWe conducted a retrospective cohort study at Kasturba Hospital, Manipal Academy of Higher Education. All hospitalized adult patients diagnosed with pulmonary TB (PTB) and extrapulmonary TB (EPTB) between June 1st 2015 and June 30th 2016 were eligible for inclusion. Pediatric and pregnant TB patients were excluded from our study. Data were extracted from medical charts. Descriptive and multivariate analyses were performed in R. Multivariate analysis adjusted for age, gender, type of TB, history of TB, and nutrition (body mass index (BMI)) status.ResultsA total of 728 patients met the eligibility criteria, 517 (71%) were male, 210 (29%) female, 406 (56%) had PTB and 322 (44%) had EPTB. Amongst those with a nutritional status, 36 (30%) patients were underweight (BMI <18.4 kg/m2), 73 (40%) had a normal BMI (18.5kg/m2–24.9 kg/m2), 15 (8%) were overweight (BMI 25.0 kg/m2–29.9 kg/m2) and 9 (5%) were obese (BMI >30.0 kg/m2). A total of 720 (98.9%) of TB patients had at least one blood sugar test result. The overall prevalence of DM (n = 184) amongst TB patients was 25.3% (95% CI 22.2%, 28.6%). When stratified, it was 35.0% (30.4%, 39.9%) and 13.0% (9.7%, 17.3%) amongst PTB and EPTB patients respectively. TB patients aged 41–60 years had 3.51 times higher odds (aOR 3.51 (2.08, 6.07)) of having DM than patients 40 years or younger. Patients aged 60 years or older had 2.49 times higher odds (aOR 2.49 (1.28, 4.85)) of having DM than younger patients (<40 years). Females had lower odds (aOR 0.80 (0.46, 1.37)) of developing DM than male TB patients and patients with a history of TB had lower odds (aOR 0.73 (0.39, 1.32)) than newly diagnosed TB patients. Additionally, EPTB patients had significantly lower odds (aOR 0.26 (0.15, 0.43)) compared to PTB patients. Underweight patients also had significantly lower odds (aOR 0.25 (0.14, 0.42)) of having DM than normal weight patients.ConclusionOur study found a higher prevalence of TB-DM than the national average. TB-DM co-prevalence was significantly associated with age, type of TB and undernutrition. As India’s DM prevalence is expected to rise, TB-DM will become an increasingly important part of the TB epidemic requiring specialized study and care.

TB-diabetes comorbidity and associated factors in Maekel Zone, Eritrea: A cross sectional study.

“…Many studies showed that male TB patients were more likely to suffer from TB-diabetes comorbidity than female TB patients [19,20,22,23,24]. The current study had also a consistent finding in which male subjects were proportionally dominant in both TB-diabetes cases and those without diabetes.…”

“…Higher prevalence of TB-diabetes comorbidity was also reported from Ethiopia 8.5% [19], Portugal 6% [20], Mexico 29.63% [21], Iran 24.3% [22], and India 25.3% [23]. The prevalence of diabetes among TB patients observed in this study is comparable to the occurrence of the disease in the general population.…”

“…Prior study revealed that TB patients aged 41and above had higher odds of having diabetes than younger patients [23]. Other literature also noted increasing age, family history of diabetes, sedentary occupation, body mass index, type of TB, category of TB, and smoking were significantly associated [24,26].…”

Nutritional assessment among adult patients with suspected or confirmed active tuberculosis disease in rural India

“…In a study among individuals with active TB disease in Chhattisgarh, over 80% of men and 90% of women had BMI < 18.5 kg/m 2 prior to anti-TB treatment [33], which was higher than among our participants. Another study in Karnataka found that 30% of patients with pulmonary or extrapulmonary active TB disease had BMI <18.4 kg/m 2 [34]. Our finding that 2.8% of study participants had BMI � 30 kg/m 2 was lower than WHO obesity estimates for India (4.9%) and globally (11% men, 15% women) [35].…”

Prevalence of hypothyroidism in patients with type 2 diabetes mellitus attending a tertiary care hospital in a rural area of Bihar, India

“…The prevalence of DM is increasing worldwide, with the global prevalence expected to double by 2030 while in India, the prevalence of DM is estimated to be 7.3%. 1 DM is the most common chronic endocrine disease characterized by hyperglycemia resulted from impaired insulin secretion and/or insulin action. Chronic diabetic hyperglycemia is associated with long-term organ damage, dysfunction and failure.…”