The Effect of Collaborative Care on Treatment Outcomes of Newly Diagnosed Tuberculosis Patients with Type-2 Diabetes Mellitus and Adverse Drug Reaction Presentations

Abstract

Background: The burdens of tuberculosis (TB) and diabetes mellitus (DM) in Nigeria are high. DM often goes unrecognized in TB patients, resulting in poorer treatment outcomes compared with TB patients only. This study set out to compare TB treatment outcomes and associated factors in TB only and TBDM patients when a collaborative care (CC) model is in place. Methods: A prospective quasi-experimental study, modeled after the World Health Organization and The Union's Collaborative Framework for Care and Control of TB and DM was carried out among TB patients in two chest clinics in Lagos state. Patients were grouped into TB only, who received the usual TB care, directly observed treatment, short course (DOTS), and TBDM, who received DOTS and CC. Data were analyzed with IBM Statistical Package for the Social Sciences, version 23.0. Chi-square and multivariate analysis determined the association between treatment success and CC. Statistical tests were calculated at 95% confidence intervals and considered significant when P value is < 0.05. Results: Of 671 participants in the study, 52 (7.7%) had DM. At TB treatment completion, there was no statistically significant difference in outcomes between TBDM and TB-only patients (P = 0.40). Patients who received CC were about 32 (OR: 31.60, 95% CI: 3.38-293), and 5 times (OR: 5.08, 95% CI: 1.35-19.17) more likely to achieve success and cure, respectively, compared to those who did not. Conclusion: Provision of CC with DOTS ensured improved TB treatment outcomes in TBDM patients. Recommendations of WHO/The Union are feasible in our setting.

Diabetes mellitus is associated with an increased risk of unsuccessful treatment outcomes among drug-susceptible tuberculosis patients in Ethiopia: A prospective health facility-based study

“…Limited evidence from Ethiopia and nearby regions suggests the adverse effect of diabetes on TB outcomes may be greater than in Asia or other settings where the TB-diabetes relationship has been evaluated [20] , [23] . For example, two studies—one from Nigeria [24] and one from Tanzanian [25] did not report a significant increased risk of unfavourable outcomes in patients with TB and diabetes. Another study from Tanzania, reported that patients with TB and hyperglycaemia had three times (aOR, 3.3; 95% CI, 1.2–9.3) higher odds of poor treatment outcome (failure or death) than patients without diabetes [26] .…”

Development and evaluation of an early rehabilitation nursing program for patients with pulmonary tuberculosis

“…Researchers in different countries generally believe that the choice of the nursing method directly affects the rehabilitation efficiency and long-term prognosis of patients with pulmonary tuberculosis. [42–44] Some scholars believe that early rehabilitation nursing can promote rehabilitation of pulmonary function through timely and comprehensive rehabilitation means. [45] Greening et al [46] reported that, a series of rehabilitation training measures included in an early pulmonary rehabilitation program improved the recovery speed of patients, shortened their hospital stay, and reduced their economic burden.…”

Tuberculosis (TB) treatment challenges in TB-diabetes comorbid patients: a systematic review and meta-analysis

“…The WHO and the International Union Against TB and Lung Disease (IUATLD) framework aims to reduce the dual burden of TB and DM in affected populations through mutual efforts and developing effective treatment approaches [ 13 ]. Thus, the Directly Observed Treatment-Short Course (DOTS) Programme was introduced by WHO in 1993 and implemented in 187 countries in 2005 [ 14 ].…”