The Footprint of Diabetes Mellitus on the Characteristics and Response to Anti-Tuberculous Therapy in Patients with Pulmonary Tuberculosis from Saudi Arabia

Abstract

Background Right now, a tuberculosis (TB) and diabetes mellitus (DM) syndemic is re-emerging worldwide. Given the contradictory results of the impact of DM on the natural history of pulmonary TB (PTB), this study was undertaken to shed light on the precision of this hypothesis from a community with a substantial caseload of both diseases. Methods The present 5-year, retrospective, cohort study involved 487 (60.8% males, and 39.2% females) adult PTB patients (mean age 53.71 ± 15.78 years) selected from Dr. Soliman Fakeeh Hospital (DSFH), Jeddah, Kingdom of Saudi Arabia (KSA). The relevant patients’ clinical, radiological and microbiological data were extracted from the hospital medical and laboratory database. Results In our study, the cumulative prevalence of DM among PTB subjects was 27.1%. Both diabetic and non-diabetic groups were matched with regard to gender ( p = 0.46); however, diabetic patients were significantly older ( p = 0.0001). Patients with concomitant DM displayed higher frequency of the classic clinical presentations of PTB and were 1.8 times more likely to have cavitary lesions on imaging studies ( p = 0.012). Furthermore, diabetic patients showed higher initial sputum acid-fast bacillus (AFB) smear grade ( p = 0.0001) and were more prone to have delayed culture conversion as compared to their non-diabetic counterparts (77.55 ± 37.74 versus 54.95 ± 27.67 days, respectively; p = 0.0001) which points out to less favorable treatment outcome. Conclusion DM showed an impact on different aspects of PTB. Accordingly, integrated bi-directional screening programs for both diseases in the KSA need to be implemented to upgrade health-care services of patients with dual diagnosis.

The effect of diabetes mellitus on tuberculosis in eastern China: A decision‐tree analysis based on a real‐world study

“…In addition, compared with the overall prevalence of DM in European patients with TB (7.5%), 6 the prevalence of DM among patients with TB in China is higher. In contrast, its prevalence is lower than that in India (28%), 20 Qatar (17%), 21 and Saudi Arabia (27.1%) 22 . This may be attributed to the effort of the Chinese National Basic Public Health Service Program, but monitoring management and public awareness still require further improvement.…”

“…29 In addition, patients with DM are more likely to have pulmonary cavities. 10,21,22 Study results have shown that abnormal opacities over the lower lung field, pulmonary cavities, and cavity nodules were more frequent among patients with TB-DM. 9 Armstrong et al found that the probability of cavitary TB was as high as 70% and the probability of smearpositive TB was as high as 50% in patients with DM according to the data shown in the 2010-2017 report of the American Tuberculosis Surveillance System.…”

“…Patients with TB‐DM have been reported to have a higher prevalence of sputum smear positivity 29 . In addition, patients with DM are more likely to have pulmonary cavities 10,21,22 . Study results have shown that abnormal opacities over the lower lung field, pulmonary cavities, and cavity nodules were more frequent among patients with TB‐DM 9 .…”

“…In contrast, its prevalence is lower than that in India (28%), 20 Qatar (17%), 21 and Saudi Arabia (27.1%). 22 This may be attributed to the effort of the Chinese National Basic Public Health Service Program, but monitoring management and public awareness still require further improvement. Strengthen the integration of monitoring and evaluation to achieve horizontal-vertical integration.…”