Sex differences in the impact of diabetes mellitus on tuberculosis recurrence: a retrospective national cohort study

Hyperglycemia and type 2 diabetes mellitus associate with postoperative recurrence in chronic rhinosinusitis patients

OBJECTIVE

To investigate the associations between fasting blood glucose (FBG) and type 2 diabetes mellitus (T2DM) and the risk of postoperative CRS recurrence.

METHODS

A retrospective cohort study was conducted on clinical data of CRS patients who underwent surgery at our center between February 2019 and March 2022 and were followed up until June 2023. All CRS patients were categorized into two subgroups based on the presence of T2DM and postoperative recurrence. The Kaplan-Meier survival curves and binary logistic regression analyses were performed to examine the associations between FBG, T2DM, and the risk of postoperative CRS recurrence.

RESULTS

1163 CRS patients were enrolled, including 134 in the T2DM group and 276 in the recurrent group. The recurrence rate in the T2DM group was significantly higher than that in the non-T2DM group (P < 0.05). T2DM prevalence and FBG levels were higher in the recurrent CRS group than in the non-recurrent CRS group (P < 0.05). The Kaplan-Meier survival curves and unadjusted and adjusted logistic regression models showed that T2DM was an independent risk factor for postoperative CRS recurrence (P < 0.05). Moreover, multivariate logistic regression analysis suggested that FBG, CRS duration, and allergic rhinitis were associated with the risk of postoperative CRS recurrence (P < 0.05).

CONCLUSION

Elevated FBG levels and accompanying T2DM were associated with an increased risk of postoperative CRS recurrence, which was independent of traditional risk factors. CRS duration and accompanying allergic rhinitis were also proven to be potential risk factors for postoperative CRS recurrence.

Age-period-cohort analysis and prediction of tuberculosis trends in China-based on the Global Burden of Disease 2021 data

Background

This study explores the epidemic trend of tuberculosis (TB) in China from 1990 to 2021, analyzes its relationship with age-period-cohort factors from 1992 to 2021, and predicts the development trend of TB in China from 2022 to 2046.

Methods

Annual Percent Change (APC), Average Annual Percent Change (AAPC) and 95% confidence interval (CI) were calculated by Joinpoint regression model to describe the epidemic trend of TB in China. The Age-Period-Cohort (APC) model was used to explore the effects of age, period and cohort effects on the trend of TB incidence rate, mortality and DALYs rate. APC model and Bayesian Age-Period-Cohort (BAPC) model were used to predict the epidemic trend of TB in China from 2022 to 2046.

Results

In 2021, it is estimated that there are 617,700 incidence cases of TB, 37,300 deaths and 1,375,500 DALYs cases in China, and the corresponding number of male cases is higher than that of female cases. From 1990 to 2021, the number of TB incidence, deaths and DALYs, as well as ASIR, ASDR and ASR of DALYs in China decreased year by year. The AAPC of ASIR, ASDR and ASR of DALYs were -3.33, -7.28% and -6.77%, respectively, all p < 0.05, indicating that the overall trend showed a significant decrease. With the increase of age, the incidence rate of TB first decreased, then increased and then decreased, while the mortality and DALYs rate first decreased rapidly and then decreased slowly, and both reached the highest value in the <5 years age group. The period effect showed that the risk of the total population, male and female population decreased overall. The cohort effect showed that the risk of TB incidence rate, mortality and DALYs rate decreased significantly. The ASIR, ASDR and ASR of DALYs of TB in China are predicted to decrease year by year from 2022 to 2046. The BAPC model predicts that the number of incidence, deaths and DALYs will reach 177,100,077,000 and 181,700 in 2046, respectively.

Conclusion

The APC model shows that the earlier the contemporary people are born, the older the age, the higher the risk of disease. APC and BAPC models predict that the ASR of TB in China will decrease year by year, but men and the older adult are still at high risk of TB burden in China. It is recommended to strengthen the screening of TB patients in key populations, especially in the older adult.

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

BACKGROUND

The Directly Observed Treatment-Short Course (DOTS) Programme was implemented by WHO and includes a combination of four anti-tuberculosis (TB) drugs (isoniazid, pyrazinamide, ethambutol and rifampicin) for a period of six months to eradicate the TB infection completely. Diabetes mellitus (DM) is recognized as one of a strong contributor of TB according to World Health Organization (WHO). The presence of diabetes mellitus type 2 (DM type 2) makes TB treatment complicated. Thus, the objective of the current meta-analysis was to identify and quantify the impact of type 2 DM on treatment outcomes of TB patients treated under the DOTS Programme.

METHODS

This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Through a systematic review of relevant literature, we focused on studies investigating treatment outcomes including extended treatment duration and recurrence for individuals with both TB and DM undergoing DOTS therapy. The extracted information included study designs, sample sizes, patient characteristics and reported treatment results.

RESULTS

In 44 studies from different parts of the world, the pooled HR for the impact of DM on extended treatment duration and reoccurrence were HR 0.72, 95% CI 0.56-0.83, p < .01 and HR 0.93, 95% CI 0.70-1.04, p = .08, respectively. The pooled HR for impact of DM on composite TB treatment outcomes was calculated as 0.76 (95% CI 0.60-0.87), p < .01 with an effect size of 41.18. The heterogeneity observed among the included studies was moderate (I2 = 55.79%).

CONCLUSIONS

A negative impact of DM was found on recurrence and extended treatment duration in TB patients treated with DOTS therapy. DM type 2 is responsible for the TB treatment prolongation and TB recurrence rates. By implementing effective management strategies and advancing research, the challenges can be mitigated, arising due to the complex interaction between DM and TB.

The impact of diabetes mellitus on tuberculosis recurrence in Eastern China: a retrospective cohort study

BACKGROUND

The comorbidity of tuberculosis (TB) and diabetes mellitus (DM) is a significant global public health issue. This study aims to explore the recurrence risk and related factors of active pulmonary TB, specifically focusing on the impact of DM.

METHODS

A retrospective cohort study was conducted in Lianyungang City, Jiangsu Province, Eastern China by recruiting 12,509 individuals with newly diagnosed pulmonary TB between 2011 and 2019. The Cox proportional hazards models were performed to identify risk factors of recurrence and assess the association between DM and recurrence. The hazard ratio (HR) and 95% confidence interval (CI) were used to estimate the strength of the association.

RESULTS

After a median follow-up period of 5.46 years, we observed 439 recurrent cases (incident recurrence rate: 6.62 per 1000 person-years). Males (HR: 1.30, 95% CI: 1.03-1.64), patients aged ≥ 60 years (HR: 1.39, 95% CI: 1.15-1.70), DM (HR: 2.40, 95% CI: 1.68-3.45), and etiologic positivity in the initial episode (HR: 2.42, 95% CI: 2.00-2.92) had a significantly increased risk of recurrence.

CONCLUSIONS

Recurrence of pulmonary TB patients who have completed treatment, especially those who also suffer from DM, should be a concern. Enhanced follow-up and targeted surveillance of these high-risk groups are needed.

Low household income increases the risk of tuberculosis recurrence: a retrospective nationwide cohort study in South Korea

OBJECTIVES

We assessed the impact of household income on tuberculosis (TB) recurrence and the long-term impact of TB on household income.

STUDY DESIGN

This was a retrospective nationwide cohort study of patients with drug-susceptible TB (DS-TB) and TB recurrence.

METHODS

Using the South Korean national TB cohort database, we identified a sub-set cohort of patients with newly diagnosed drug-susceptible TB between 2013 and 2016 and tracked their TB recurrence and longitudinal income data from 2007 to 2018. Income levels were evaluated as 'Medical aid' and quintile categories. To assess risk factors associated with TB recurrence, we used a sub-distribution hazard model, adjusting for the competing risks of death.

RESULTS

Of 66,690 patients successfully treated with DS-TB, 2095 (3.1 %) experienced recurrence during a median follow-up of 39 months. The incidence of TB recurrence was 982.1/100,000 person-years, with 50.3 % of the recurrences occurring within 1 year of treatment completion. The risk of TB recurrence increased with decreasing income levels, with the highest risk observed in the lowest income group. The effect of income on TB recurrence was prominent in males but not in females. Overall, patients with TB recurrence experienced a linear decline in income levels, compared with those without recurrence.

CONCLUSIONS

Household income during the initial TB episode was an important risk factor for TB recurrence, particularly in males.

Prevalence and associated factors of diabetes mellitus among patients with tuberculosis in South Korea from 2011 to 2018: a nationwide cohort study

OBJECTIVES

This study aimed to identify the prevalence of diabetes mellitus (DM) among patients with tuberculosis (TB) using a nationwide cohort in South Korea.

DESIGN

A retrospective cohort study.

SETTING

This study used the Korean Tuberculosis and Post-Tuberculosis cohort, which was constructed by linking the Korean National Tuberculosis Surveillance, National Health Information Database (NHID) and Statistics Korea data for the causes of death.

PARTICIPANTS

During the study period, all notified patients with TB with at least one claim in the NHID were included. Exclusion criteria were age less than 20 years, drug resistance, initiation of TB treatment before the study period and missing values in covariates.

OUTCOME MEASURES

DM was defined as having at least two claims of the International Classification of Diseases (ICD) code for DM or at least one claim of the ICD code for DM and prescription of any antidiabetic drugs. Newly diagnosed DM (nDM) and previously diagnosed DM (pDM) were defined as DM diagnosed after and before TB diagnosis, respectively.

RESULTS

A total of 26.8% (70 119) of patients were diagnosed with DM. The age-standardised prevalence increased as age increased or income decreased. Patients with DM were more likely to be men, older, had the lowest income group, had more acid-fast bacilli smear and culture positivity, had a higher Charlson Comorbidity Index score and had more comorbidities compared with patients without DM. Approximately 12.5% (8823) patients had nDM and 87.4% (61 296) had pDM among those with TB-DM.

CONCLUSIONS

The prevalence of DM among patients with TB was considerably high in Korea. To achieve the goal of TB control and improve the health outcomes of both TB and DM, integrated screening of TB and DM and care delivery in clinical practice are necessary.