Results of the Implementation of a Pilot Model for the Bidirectional Screening and Joint Management of Patients with Pulmonary Tuberculosis and Diabetes Mellitus in Mexico

Abstract

BackgroundRecently, the World Health Organisation and the International Union Against Tuberculosis and Lung Disease published a Collaborative Framework for the Care and Control of Tuberculosis (TB) and Diabetes (DM) (CFTB/DM) proposing bidirectional screening and joint management.ObjectiveTo evaluate the feasibility and effectiveness of the CFTB/DM in Mexico. Design. Prospective observational cohort. Setting. 15 primary care units in 5 states in Mexico. Participants: Patients aged ≥20 years diagnosed with DM or pulmonary TB who sought care at participating clinics. Intervention: The WHO/Union CFTB/DM was adapted and implemented according to official Mexican guidelines. We recruited participants from July 2012 to April 2013 and followed up until March 2014. Bidirectional screening was performed. Patients diagnosed with TB and DM were invited to receive TB treatment under joint management. Main outcome measures. Diagnoses of TB among DM, of DM among TB, and treatment outcomes among patients with DM and TB.ResultsOf 783 DM patients, 11 (1.4%) were unaware of their TB. Of 361 TB patients, 16 (4.4%) were unaware of their DM. 95 TB/DM patients accepted to be treated under joint management, of whom 85 (89.5%) successfully completed treatment. Multiple linear regression analysis with change in HbA1c and random capillary glucose as dependent variables revealed significant decrease with time (regression coefficients (β) = −0.660, (95% confidence interval (CI), −0.96 to −0.35); and β = −1.889 (95% CI, −2.77 to −1.01, respectively)) adjusting by sex, age and having been treated for a previous TB episode. Patients treated under joint management were more likely to experience treatment success than patients treated under routine DM and TB programs as compared to historical (adjusted OR (aOR), 2.8, 95%CI 1.28–6.13) and same period (aOR 2.37, 95% CI 1.13–4.96) comparison groups.ConclusionsJoint management of TB and DM is feasible and appears to improve clinical outcomes.

Prevalence and Associated Factors of Diabetes Mellitus among Tuberculosis Patients in South-Eastern Amhara Region, Ethiopia: A Cross Sectional Study

“…The proportion of new DM cases 64 (4.9%) identified in our study is similar to the study done in India (5%) [ 30 ], but higher than from China (3%), Gujarat-India (4%), Saluru–India (3.2%), Kolar–India (2.9%) and Mexico (4.4%) [ 25 – 28 , 31 ] and lower than the study finding in Trivandrum-India (7%) [ 32 ]. The relatively high proportion of undiagnosed DM in the study may indicate the magnitude of the disease, low awareness, lack of access to DM services, the importance of DM screening among TB patients which is crucial for early diagnosis and treatment of the two comorbid conditions [ 18 – 19 , 27 , 31 , 33 ].…”

The effect of diabetes control status on treatment response in pulmonary tuberculosis: a prospective study

“…However, this study assessed the status of glucose control only by medical records documented by a nurse or physician prior to treatment of TB 32. One prospective study suggested that joint management of TB and DM improve clinical outcomes 33. However, in this study, the control groups were extracted from the previous National Register of Cases of TB.…”

Screening for pulmonary tuberculosis in type 2 diabetes elderly: a cross-sectional study in a community hospital

“…The incidence rate increases with HbA1c level and diabetes duration, especially in patients with HbA1c over 9.0% and with diabetes duration over 10 years [ 16 ]. Another symptom screening research in Mexico detected 38 TB cases in 7,763 diabetes patients and 11 of them were unaware of their TB [ 17 ]. These studies pointed out that active screening and better glucose control might be important in TB prevention.…”

“…Many risk factors have been associated with TB, such as male gender [ 1 ], cigarette smoking [ 3 , 4 ], alcohol consumption [ 5 ], underweight [ 6 ], renal disease [ 7 ], household contact [ 8 ], socioeconomic status [ 9 ], and diabetes mellitus [ 10 ]. As diabetes patients increased year by year, more and more studies focused on TB prevention in diabetic group in these years [ 10 – 17 ].…”

“…Diabetes patients also require longer treatment and are more likely to develop multi-drug resistant tuberculosis [ 21 ]. Additionally, joint management of both diseases appears to improve clinical outcomes [ 17 ]. However, most studies to date have employed case control or cohort design.…”