1
|
Bailey SL, Floyd S, Cheeba-Lengwe M, Maluzi K, Chiwele-Kangololo K, Kaluba-Milimo D, Amofa-Sekyi M, Yudkin JS, Godfrey-Faussett P, Ayles H. The Effect of HIV on the Association of Hyperglycaemia and Active Tuberculosis in Zambia, a Case-Control Study. J Epidemiol Glob Health 2024:10.1007/s44197-024-00236-2. [PMID: 38713341 DOI: 10.1007/s44197-024-00236-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES To determine if HIV modifies the association between hyperglycaemia and active tuberculosis in Lusaka, Zambia. METHODS A case-control study among newly-diagnosed adult tuberculosis cases and population controls in three areas of Lusaka. Hyperglycaemia is determined by random blood glucose (RBG) concentration measured at the time of recruitment; active tuberculosis disease by clinical diagnosis, and HIV status by serological result. Multivariable logistic regression is used to explore the primary association and effect modification by HIV. RESULTS The prevalence of RBG concentration ≥ 11.1 mmol/L among 3843 tuberculosis cases was 1.4% and among 6977 controls was 1.5%. Overall, the adjusted odds ratio of active tuberculosis was 1.60 (95% CI 0.91-2.82) comparing those with RBG concentration ≥ 11.1- < 11.1 mmol/L. The corresponding adjusted odds ratio among those with and without HIV was 5.47 (95% CI 1.29-23.21) and 1.17 (95% CI 0.61-2.27) respectively; p-value for effect modification by HIV = 0.042. On subgroup analysis, the adjusted odds ratio of smear/Xpert-positive tuberculosis was 2.97 (95% CI 1.49-5.90) comparing RBG concentration ≥ 11.1- < 11.1 mmol/L. CONCLUSIONS Overall, no evidence of association between hyperglycaemia and active tuberculosis was found, though among those with HIV and/or smear/Xpert-positive tuberculosis there was evidence of association. Differentiation of hyperglycaemia caused by diabetes mellitus and stress-induced hyperglycaemia secondary to tuberculosis infection is important for a better understanding of these findings.
Collapse
Affiliation(s)
- Sarah Lou Bailey
- LSHTM TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK.
- Zambart, Lusaka, Zambia.
| | - Sian Floyd
- LSHTM TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | | | | | | | - John S Yudkin
- Division of Medicine, University College London, London, UK
| | - Peter Godfrey-Faussett
- LSHTM TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Helen Ayles
- LSHTM TB Centre and Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
- Zambart, Lusaka, Zambia
| |
Collapse
|
2
|
Oliveira Hashiguchi L, Ferrer JP, Suzuki S, Faguer BN, Solon JA, Castro MC, Ariyoshi K, Cox SE, Edwards T. Glycemic control during TB treatment among Filipinos: The Starting Anti-Tuberculosis Treatment Cohort Study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003156. [PMID: 38696522 PMCID: PMC11065219 DOI: 10.1371/journal.pgph.0003156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 04/03/2024] [Indexed: 05/04/2024]
Abstract
Poor TB treatment outcomes are observed in patients with type 2 diabetes mellitus (DM) comorbidity and glycemic control throughout treatment may play a role. The objective of this study was to investigate glycemic control longitudinally among Filipino adults undergoing TB treatment using mixed-effects linear and logistic regression. Analyses were conducted in 188 DM-TB patients out of 901 enrolled in the Starting Anti-TB Treatment (St-ATT) cohort, with a median baseline glycosylated hemoglobin (HbA1c) of 8.2% (range 4.5-13.3%). Previous versus new DM diagnosis was associated with higher mean HbA1c (worse glycemic control) during treatment, with a smaller effect amongst those with central obesity (coefficient 0.80, 95% confidence interval [CI] 0.26, 1.57, P = 0.043) than amongst those without central obesity (coefficient 3.48, 95% CI 2.16, 4.80, P<0.001). In those with a new DM diagnosis, central obesity was associated with higher blood glucose (coefficient 1.62, 95% CI 0.72, 2.53, P = 0.009). Of 177 participants with ≥2 HbA1c results, 40% had uncontrolled glycemia (≥2 HbA1c results ≥8%). Of 165 participants with ≥3 HbA1c results, 29.9% had consistently-controlled glycemia, 15.3% had initially-uncontrolled glycemia, and 18.6% had consistently-uncontrolled glycemia. Previous versus new DM diagnosis and glucose-lowering medication use versus no use were associated with having uncontrolled versus controlled glycemia (adjusted odds ratio [aOR] 2.50 95%CI 1.61, 6.05, P = 0.042; aOR 4.78 95% CI 1.61,14.23, P<0.001) and more likely to have consistently-uncontrolled versus consistently-controlled glycemia (adjusted relative risk ratio [aRRR] 5.14 95% CI 1.37, 19.20, P = 0.015; aRRR 10.24 95% CI 0.07, 0.95, P = 0.003). Relapse cases of TB were less likely than new cases to have uncontrolled (aOR 0.20 95%CI 0.06, 0.63, P = 0.031) or consistently-uncontrolled (aRRR 0.25 95%CI 0.07, 0.95, P = 0.042) versus controlled glycemia. Those with long-term DM, suggested by previous diagnosis, glucose-lowering medication use and possibly central obesity, may require additional support to manage blood glucose during TB treatment.
Collapse
Affiliation(s)
- Lauren Oliveira Hashiguchi
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | | | - Shuichi Suzuki
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | - Benjamin N. Faguer
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | - Juan Antonio Solon
- Nutrition Center of the Philippines, Muntinlupa City, Manila, Philippines
| | | | - Koya Ariyoshi
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | - Sharon E. Cox
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Tuberculosis Unit, United Kingdom Health Security Agency, London, United Kingdom
| | - Tansy Edwards
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
- Medical Research Council International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, London, United Kingdom
| |
Collapse
|
3
|
Salindri AD, Kipiani M, Lomtadze N, Tukvadze N, Avaliani Z, Blumberg HM, Masyn KE, Rothenberg RB, Kempker RR, Magee MJ. HIV co-infection increases the risk of post-tuberculosis mortality among persons who initiated treatment for drug-resistant tuberculosis. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2023.05.19.23290190. [PMID: 37293036 PMCID: PMC10246159 DOI: 10.1101/2023.05.19.23290190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Little is known regarding the relationship between common comorbidities in persons with tuberculosis (TB) (including human immunodeficiency virus [HIV], diabetes, and hepatitis C virus [HCV]) with post-TB mortality. We conducted a retrospective cohort study among persons who initiated treatment for rifampicin-resistant and multi/extensively drug-resistant (RR and M/XDR) TB reported to the country of Georgia's TB surveillance during 2009-2017. Exposures included HIV serologic status, diabetes, and HCV status. Our outcome was all-cause post-TB mortality determined by cross-validating vital status with Georgia's death registry through November 2019. We estimated adjusted hazard rate ratios (aHR) and 95% confidence intervals (CI) of post-TB mortality among participants with and without comorbidities using cause-specific hazard regressions. Among 1032 eligible participants, 34 (3.3%) died during treatment and 87 (8.7%) died post-TB treatment. Among those who died post-TB treatment, the median time to death was 21 months (interquartile range 7-39) post-TB treatment. After adjusting for confounders, the hazard rates of post-TB mortality were higher among participants with HIV co-infection (aHR=3.74, 95%CI 1.77-7.91) compared to those without HIV co-infection. In our cohort, post-TB mortality occurred most commonly in the first three years post-TB treatment. Linkage to care for common TB comorbidities post-treatment may reduce post-TB mortality rates.
Collapse
Affiliation(s)
- Argita D. Salindri
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA; and Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Maia Kipiani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; David Tvildiani Medical University, Tbilisi, Georgia; and The University of Georgia, Tbilisi, Georgia
| | - Nino Lomtadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; David Tvildiani Medical University, Tbilisi, Georgia; and The University of Georgia, Tbilisi, Georgia
| | - Nestani Tukvadze
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; and Department of Medicine, Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | - Zaza Avaliani
- National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia; and European University, Tbilisi, Georgia
| | - Henry M. Blumberg
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA; Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Katherine E. Masyn
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA, Atlanta, GA, USA
| | - Richard B. Rothenberg
- Department of Population Health Sciences, Georgia State University School of Public Health, Atlanta, GA, USA, Atlanta, GA, USA
| | - Russell R. Kempker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew J. Magee
- Hubert Department of Global Health and Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA; and Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| |
Collapse
|
4
|
Jiang Y, Zhang W, Wei M, Yin D, Tang Y, Jia W, Wang C, Guo J, Li A, Gong Y. Associations between type 1 diabetes and pulmonary tuberculosis: a bidirectional mendelian randomization study. Diabetol Metab Syndr 2024; 16:60. [PMID: 38443967 PMCID: PMC10913601 DOI: 10.1186/s13098-024-01296-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/20/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) has been associated with higher pulmonary tuberculosis (PTB) risk in observational studies. However, the causal relationship between them remains unclear. This study aimed to assess the causal effect between T1DM and PTB using bidirectional Mendelian randomization (MR) analysis. METHODS Single nucleotide polymorphisms (SNPs) of T1DM and PTB were extracted from the public genetic variation summary database. In addition, GWAS data were collected to explore the causal relationship between PTB and relevant clinical traits of T1DM, including glycemic traits, lipids, and obesity. The inverse variance weighting method (IVW), weighted median method, and MR‒Egger regression were used to evaluate the causal relationship. To ensure the stability of the results, sensitivity analyses assess the robustness of the results by estimating heterogeneity and pleiotropy. RESULTS IVW showed that T1DM increased the risk of PTB (OR = 1.07, 95% CI: 1.03-1.12, P < 0.001), which was similar to the results of MR‒Egger and weighted median analyses. Moreover, we found that high-density lipoprotein cholesterol (HDL-C; OR = 1.28, 95% CI: 1.03-1.59, P = 0.026) was associated with PTB. There was no evidence of an effect of glycemic traits, remaining lipid markers, or obesity on the risk of PTB. In the reverse MR analysis, no causal relationships were detected for PTB on T1DM and its relevant clinical traits. CONCLUSION This study supported that T1DM and HDL-C were risk factors for PTB. This implies the effective role of treating T1DM and managing HDL-C in reducing the risk of PTB, which provides an essential basis for the prevention and comanagement of concurrent T1DM and PTB in clinical practice.
Collapse
Affiliation(s)
- Yijia Jiang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700, Beijing, China
| | - Wenhua Zhang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700, Beijing, China
| | - Maoying Wei
- Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700, Beijing, China
| | - Dan Yin
- Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700, Beijing, China
| | - Yiting Tang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700, Beijing, China
| | - Weiyu Jia
- Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700, Beijing, China
| | - Churan Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700, Beijing, China
| | - Jingyi Guo
- Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700, Beijing, China
| | - Aijing Li
- Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700, Beijing, China
| | - Yanbing Gong
- Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700, Beijing, China.
| |
Collapse
|
5
|
Kibirige D, Andia-Biraro I, Olum R, Adakun S, Zawedde-Muyanja S, Sekaggya-Wiltshire C, Kimuli I. Tuberculosis and diabetes mellitus comorbidity in an adult Ugandan population. BMC Infect Dis 2024; 24:242. [PMID: 38389045 PMCID: PMC10885501 DOI: 10.1186/s12879-024-09111-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) has a direct impact on the clinical manifestation and prognosis of active tuberculosis disease (TB) and is known to increase the chance of developing the condition. We sought to determine the prevalence of DM in adult Ugandan patients with recently diagnosed TB and the associated sociodemographic, anthropometric, and metabolic characteristics of TB-DM comorbidity. METHODS In this cross-sectional study conducted at the adult TB treatment centres of three tertiary healthcare facilities in Uganda, we screened adult participants with recently diagnosed TB (diagnosed in < 2 months) for DM. All participants were screened with five tests; initially with a random blood glucose (RBG) test, and then later with fasting blood glucose (FBG), laboratory-based glycated hemoglobin (HbA1c), point-of-care (POC) HbA1c, and oral glucose tolerance test (OGTT) if the RBG was ≥ 6.1 mmol/l. The WHO guidelines for diagnosing and managing DM were used to support the DM diagnosis. To identify the factors associated with DM-TB comorbidity, logistic regression was used. RESULTS A total of 232 participants with recently diagnosed TB were screened for DM. Of these, 160 (69%) were female. The median (IQR) age, body mass index, and RBG of all study participants was 35 (27-42) years, 19.2 (17.6-21.3) kg/m2, and 6.1 (5.5-7.2) mmol/l, respectively. About half of the participants (n = 117, 50.4%) had RBG level ≥ 6.1 mmol/l. Of these, 75 (64.1%) participants returned for re-testing. Diabetes mellitus was diagnosed in 32 participants, corresponding to a prevalence of 13.8% (95% CI 9.9-18.9). A new diagnosis of DM was noted in 29 (90.6%) participants. On logistic regression, age ≥ 40 years was associated with increased odds of TB and DM comorbidity (AOR 3.12, 95% CI 1.35-7.23, p = 0.008) while HIV coinfection was protective (AOR 0.27, 95% CI 0.10-0.74, p = 0.01). CONCLUSION TB and DM comorbidity was relatively common in this study population. Routine screening for DM in adult Ugandan patients with recently diagnosed TB especially among those aged ≥ 40 years and HIV-negative patients should be encouraged in clinical practice.
Collapse
Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda.
- Non-communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, Entebbe, Uganda.
| | - Irene Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- Makerere University School of Public Health, Kampala, Uganda
| | - Susan Adakun
- Adult Tuberculosis ward, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| | | | - Ivan Kimuli
- Department of Physiology, College of Health Sciences, Makerere University Kampala, Kampala, Uganda
| |
Collapse
|
6
|
Pardeshi G, Mave V, Gaikwad S, Kadam D, Barthwal M, Gupte N, Atre S, Deshmukh S, Golub JE, Gupte A. Glycated Hemoglobin Trajectories and Their Association With Treatment Outcomes Among Patients With Pulmonary TB in India: A Prospective Cohort Study. Chest 2024; 165:278-287. [PMID: 37673207 PMCID: PMC10851276 DOI: 10.1016/j.chest.2023.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 07/30/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Transient hyperglycemia is seen commonly during TB treatment, yet its association with unfavorable treatment outcomes is unclear. RESEARCH QUESTION Does an association exist between glycated hemoglobin (HbA1c) trajectories and TB treatment outcomes? STUDY DESIGN AND METHODS Adults with pulmonary TB were evaluated prospectively for 18 months after the second HbA1c measurement. HbA1c trajectories during the initial 3 months of treatment were defined as follows: persistent euglycemia, HbA1c < 6.5% at baseline and 3-month follow-up; persistent hyperglycemia, HbA1c ≥ 6.5% at baseline and 3-month follow-up; transient hyperglycemia, HbA1c ≥ 6.5% at baseline and < 6.5% at 3-month follow-up; incident hyperglycemia, HbA1c < 6.5% at baseline and ≥ 6.5% at 3-month follow-up. Multivariable Poisson regression was used to measure the association between HbA1c trajectories and unfavorable treatment outcomes of failure, recurrence, and all-cause mortality. RESULTS Of the 587 participants, 443 participants (76%) had persistent euglycemia, 118 participants (20%) had persistent hyperglycemia, and 26 participants (4%) had transient hyperglycemia. One participant had incident hyperglycemia and was excluded. Compared with participants with persistent euglycemia, those with transient hyperglycemia showed a twofold higher risk of experiencing an unfavorable treatment outcome (adjusted incidence rate ratio [aIRR], 2.07; 95% CI, 1.04-4.15) after adjusting for confounders including diabetes treatment, and BMI; we did not find a significant association with persistent hyperglycemia (aIRR, 1.64; 95% CI, 0.71-3.79). Diabetes treatment was associated with a significantly lower risk of unfavorable treatment outcomes (aIRR, 0.38; 95% CI, 0.15-0.95). INTERPRETATION Transient hyperglycemia and lack of diabetes treatment was associated with a higher risk of unfavorable treatment outcomes in adults with pulmonary TB.
Collapse
Affiliation(s)
- Geeta Pardeshi
- Department of Community Medicine, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai, India
| | - Vidya Mave
- Byramjee Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sanjay Gaikwad
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Dileep Kadam
- Byramjee Jeejeebhoy Government Medical College, Pune, India
| | - Madhusudan Barthwal
- Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Nikhil Gupte
- Byramjee Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sachin Atre
- Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Sona Deshmukh
- Byramjee Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India
| | - Jonathan E Golub
- Johns Hopkins University School of Medicine, Baltimore, MD; Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Akshay Gupte
- Department of Global Health, Boston University School of Public Health, Boston, MA.
| |
Collapse
|
7
|
Majaliwa ES, Muze K, Godfrey E, Byashalira K, Mmbaga BT, Ramaiya K, Mfinanga SG. Latent tuberculosis in children and youth with type 1 diabetes mellitus in Dar es Salaam, Tanzania: a cross section survey. BMC Infect Dis 2023; 23:740. [PMID: 37904143 PMCID: PMC10614349 DOI: 10.1186/s12879-023-08753-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/25/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Data for latent tuberculosis in patients with type 1 Diabetes in Africa is limited. We assessed the prevalence of latent tuberculosis in youth and children with type 1 Diabetes in Dar es Salaam -Tanzania. METHODS Our cross-sectional study recruited children and youth with T1DM by stage of puberty, glycaemic control, and age at diagnosis from January to December 2021 in Dar es Salaam. Participants were screened for the presence of latent Tuberculosis using the QuantiFERON test. A positive test was considered to have latent TB. RESULTS Of the 281 participants, the mean age was 19 (± 6) years, 51.2% were female, and 80.8% had either a primary or secondary level of education at baseline. The prevalence of latent TB was 14.9% and was slightly higher in females (52.4%) than in males. This difference, however, was insignificant (p > 0.05). On the other hand, the proportion of latent TB was significantly higher in uncontrolled HbA1c levels (76.2%) than in those with controlled HbA1c (23.8%) [p = 0.046]. Duration of diabetes and age at diagnosis did not affect the occurrence of latent Tuberculosis [p > 0.05]. Meanwhile, in the regression model, participants with latent TB were more likely to have uncontrolled HbA1c. [p = 0.045] CONCLUSIONS: Despite the methodological limitations, this survey highlights the high prevalence of latent TB among children and youth with diabetes; shouting for better control. These results clearly show the need to screen for Tuberculosis in children and youth with diabetes and start them on prevention as per protocol, especially in tuberculosis-endemic areas like Tanzania.
Collapse
Affiliation(s)
- Edna S Majaliwa
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania.
- Muhimbili National Hospital, Box 65000, Dar es Salaam, United Republic of Tanzania.
| | - Kandi Muze
- Muhimbili National Hospital, Box 65000, Dar es Salaam, United Republic of Tanzania
| | - Evance Godfrey
- Muhimbili National Hospital, Box 65000, Dar es Salaam, United Republic of Tanzania
| | - Kenneth Byashalira
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania
- Kibong'oto Infectious Diseases Hospital, Sanya Juu, Siha, United Republic of Tanzania
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Kilimanjaro, United Republic of Tanzania
- Kilimanjaro Clinical Research Institute, Moshi, United Republic of Tanzania
| | - Kaushik Ramaiya
- Shree Hindu Mandal Hospital, Dar es Salaam, United Republic of Tanzania
| | - Sayoki G Mfinanga
- Muhimbili Medical Research Centre, National Institute for Medical Research, Dar es Salaam, United Republic of Tanzania
- School of Public Health, Department of Epidemiology and Statistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
- Alliance for Africa Research and Innovation, Dar es Salaam, United Republic of Tanzania
| |
Collapse
|
8
|
Eckold C, van Doorn CLR, Ruslami R, Ronacher K, Riza A, van Veen S, Lee J, Kumar V, Kerry‐Barnard S, Malherbe ST, Kleynhans L, Stanley K, Joosten SA, Critchley JA, Hill PC, van Crevel R, Wijmenga C, Haks MC, Ioana M, Alisjahbana B, Walzl G, Ottenhoff THM, Dockrell HM, Vianello E, Cliff JM. Impaired resolution of blood transcriptomes through tuberculosis treatment with diabetes comorbidity. Clin Transl Med 2023; 13:e1375. [PMID: 37649224 PMCID: PMC10468587 DOI: 10.1002/ctm2.1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND People with diabetes are more likely to develop tuberculosis (TB) and to have poor TB-treatment outcomes than those without. We previously showed that blood transcriptomes in people with TB-diabetes (TB-DM) co-morbidity have excessive inflammatory and reduced interferon responses at diagnosis. It is unknown whether this persists through treatment and contributes to the adverse outcomes. METHODS Pulmonary TB patients recruited in South Africa, Indonesia and Romania were classified as having TB-DM, TB with prediabetes, TB-related hyperglycaemia or TB-only, based on glycated haemoglobin concentration at TB diagnosis and after 6 months of TB treatment. Gene expression in blood at diagnosis and intervals throughout treatment was measured by unbiased RNA-Seq and targeted Multiplex Ligation-dependent Probe Amplification. Transcriptomic data were analysed by longitudinal mixed-model regression to identify whether genes were differentially expressed between clinical groups through time. Predictive models of TB-treatment response across groups were developed and cross-tested. RESULTS Gene expression differed between TB and TB-DM patients at diagnosis and was modulated by TB treatment in all clinical groups but to different extents, such that differences remained in TB-DM relative to TB-only throughout. Expression of some genes increased through TB treatment, whereas others decreased: some were persistently more highly expressed in TB-DM and others in TB-only patients. Genes involved in innate immune responses, anti-microbial immunity and inflammation were significantly upregulated in people with TB-DM throughout treatment. The overall pattern of change was similar across clinical groups irrespective of diabetes status, permitting models predictive of TB treatment to be developed. CONCLUSIONS Exacerbated transcriptome changes in TB-DM take longer to resolve during TB treatment, meaning they remain different from those in uncomplicated TB after treatment completion. This may indicate a prolonged inflammatory response in TB-DM, requiring prolonged treatment or host-directed therapy for complete cure. Development of transcriptome-based biomarker signatures of TB-treatment response should include people with diabetes for use across populations.
Collapse
Affiliation(s)
- Clare Eckold
- Department of Infection Biology and TB CentreLondon School of Hygiene & Tropical MedicineLondonUK
| | | | - Rovina Ruslami
- Department of Biomedical SciencesFaculty of MedicineUniversitas PadjadjaranBandungIndonesia
| | - Katharina Ronacher
- DSI‐NRF Centre of Excellence for Biomedical Tuberculosis ResearchSouth African Medical Research Council Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsDepartment of Biomedical SciencesFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
- Mater Research InstituteFaculty of MedicineTranslational Research InstituteThe University of QueenslandBrisbaneQLDAustralia
| | - Anca‐Lelia Riza
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands
- Human Genomics LaboratoryDepartment of Diagnostics and TreatmentUniversity of Medicine and Pharmacy of CraiovaCraiovaRomania
- Regional Centre for Human Genetics – DoljEmergency Clinical County Hospital CraiovaCraiovaRomania
| | - Suzanne van Veen
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
| | - Ji‐Sook Lee
- Department of Infection Biology and TB CentreLondon School of Hygiene & Tropical MedicineLondonUK
| | - Vinod Kumar
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands
- Department of GeneticsUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | | | - Stephanus T. Malherbe
- DSI‐NRF Centre of Excellence for Biomedical Tuberculosis ResearchSouth African Medical Research Council Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsDepartment of Biomedical SciencesFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Léanie Kleynhans
- DSI‐NRF Centre of Excellence for Biomedical Tuberculosis ResearchSouth African Medical Research Council Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsDepartment of Biomedical SciencesFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Kim Stanley
- DSI‐NRF Centre of Excellence for Biomedical Tuberculosis ResearchSouth African Medical Research Council Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsDepartment of Biomedical SciencesFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Simone A. Joosten
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
| | - Julia A Critchley
- Population Health Research InstituteSt George'sUniversity of LondonLondonUK
| | - Philip C. Hill
- Division of Health SciencesCentre for International HealthUniversity of OtagoDunedinNew Zealand
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious DiseasesRadboud University Medical CenterNijmegenThe Netherlands
- Nuffield Department of MedicineCentre for Tropical Medicine and Global HealthUniversity of OxfordOxfordUK
| | - Cisca Wijmenga
- Department of GeneticsUniversity of GroningenUniversity Medical Center GroningenGroningenThe Netherlands
| | - Mariëlle C. Haks
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
| | - Mihai Ioana
- Human Genomics LaboratoryDepartment of Diagnostics and TreatmentUniversity of Medicine and Pharmacy of CraiovaCraiovaRomania
- Regional Centre for Human Genetics – DoljEmergency Clinical County Hospital CraiovaCraiovaRomania
| | - Bachti Alisjahbana
- Internal Medicine DepartmentHasan Sadikin General HospitalBandungIndonesia
- Research Center for Care and Control of Infectious DiseasesUniversitas PadjadjaranBandungIndonesia
| | - Gerhard Walzl
- DSI‐NRF Centre of Excellence for Biomedical Tuberculosis ResearchSouth African Medical Research Council Centre for Tuberculosis ResearchDivision of Molecular Biology and Human GeneticsDepartment of Biomedical SciencesFaculty of Medicine and Health SciencesStellenbosch UniversityCape TownSouth Africa
| | - Tom H. M. Ottenhoff
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
| | - Hazel M. Dockrell
- Department of Infection Biology and TB CentreLondon School of Hygiene & Tropical MedicineLondonUK
| | - Eleonora Vianello
- Department of Infectious DiseasesLeiden University Medical CenterLeidenThe Netherlands
| | - Jacqueline M. Cliff
- Department of Infection Biology and TB CentreLondon School of Hygiene & Tropical MedicineLondonUK
- Department of Life SciencesCentre for Inflammation Research and Translational MedicineBrunel University LondonLondonUK
| | - the TANDEM Consortium$
- Department of Infection Biology and TB CentreLondon School of Hygiene & Tropical MedicineLondonUK
| |
Collapse
|
9
|
Wang C, Yang X, Zhang H, Zhang Y, Tao J, Jiang X, Wu C. Temporal trends in mortality of tuberculosis attributable to high fasting plasma glucose in China from 1990 to 2019: a joinpoint regression and age-period-cohort analysis. Front Public Health 2023; 11:1225931. [PMID: 37575123 PMCID: PMC10413982 DOI: 10.3389/fpubh.2023.1225931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/17/2023] [Indexed: 08/15/2023] Open
Abstract
Background Nowadays, high fasting plasma glucose (HFPG) has been identified as the important risk factor contributing to the increased burden of diseases. But there remains a lack of research on tuberculosis (TB) mortality specifically attributable to HFPG. Thus, this study aims to explore the long-term trends in HFPG-related TB mortality in China from 1990 to 2019. Methods Data on HFPG-related TB mortality were obtained from the Global Burden of Disease (GBD) Study 2019. Analyzing the data using joinpoint regression and age-period-cohort methods adjusting for age, period, and cohort allowed us to assess the trends in TB mortality due to HFPG. Results The age-standardized mortality rates (ASMRs) of TB attributable to HFPG exhibited a downward trend in China from 1990 to 2019, with an average annual percentage change (AAPC) of -7.0 (95% CI, -7.5 to -6.6). Similar trends were found for male (AAPC of -6.5 [95% CI, -7.0 to -6.0]) and female (AAPC of -8.2 [95% CI, -8.5 to -7.9]), respectively. Local drifts curve with a U-shaped pattern reflected the AAPC of TB mortality due to HFPG across age groups. The greatest decline was observed in the age group of 60-64 years. The mortality rates related to HFPG first increased and then decreased with increasing age, peaking in the 55-59 age group. Our analysis of the period and cohort effects found that the rate ratios of TB mortality due to HFPG have decreased over the past three decades, more prominently in women. It is noteworthy that while both genders have seen a decline in HFPG-attributable TB mortality and risk, men have a higher risk and slightly less significant decline than women. Conclusion The present study shows that HFPG-related ASMRs and risk of TB in China decreased over the last 30 years, with similar trends observed in both men and women. In order to attain the recommended level set by the WHO, the effective strategies for glycemic control and management still needed to be implemented strictly to further decrease the burden of TB.
Collapse
Affiliation(s)
- Chao Wang
- National Center for Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xueli Yang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Honglu Zhang
- Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yanzhuo Zhang
- National Center for Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Jianfeng Tao
- National Center for Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Xu Jiang
- Department of Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Chengai Wu
- National Center for Orthopaedics, Beijing Research Institute of Traumatology and Orthopaedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
10
|
Viswanathan V, Devarajan A, Kumpatla S, Dhanasekaran M, Babu S, Kornfeld H. Effect of prediabetes on tuberculosis treatment outcomes: A study from South India. Diabetes Metab Syndr 2023; 17:102801. [PMID: 37354752 PMCID: PMC10528008 DOI: 10.1016/j.dsx.2023.102801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 04/18/2023] [Accepted: 05/28/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND AND AIMS The aim was to assess the effect of prediabetes on tuberculosis(TB) treatment outcomes. METHODS This is a prospective observational cohort study of 569 eligible new smear positive cases screened for DM between 2014 and 2018 in TB units in North Chennai, South India. Based on study criteria, a total of 187 subjects were included and categorised into two groups: TB with normoglycaemia (groupI) (HbA1c<5.7%) and TB with prediabetes (group II) (HbA1c = 5.7-6.4%) and followed them at 3rd and 6th month and treatment outcomes were assessed at the end of the TB treatment. RESULTS Total cure rate was 72.7% with no significant difference between the groups. Higher proportion of deaths occurred in group II (6.3%) compared to group I (1.3%) (p = 0.09). At the end of intensive phase of directly observed therapy (DOTS) treatment, about 23.8% were observed to have positive sputum smear in group II compared to 8.6% in group I(p = 0.019). The estimated relative risk to remain as sputum smear positive among people with prediabetes at the end of intensive phase was 3.0(95% CI: 1.2-7.6). There was a significant association found with HbA1c at enrollment and unfavourable TB treatment outcomes (β = 1.38, [odds ratio (95% CI) 3.98(1.65-9.64); p = 0.007]. CONCLUSION Death rate was high and there was a delay in sputum conversion among TB patients with prediabetes at the end of the intensive phase of TB treatment. HbA1c at the time of diagnosis of prediabetes was significantly associated with unfavourable TB treatment outcomes.
Collapse
Affiliation(s)
- Vijay Viswanathan
- Prof. M. Viswanathan Diabetes Research Centre, Royapuram, Chennai, India.
| | | | - Satyavani Kumpatla
- Prof. M. Viswanathan Diabetes Research Centre, Royapuram, Chennai, India.
| | | | - Subash Babu
- National Institutes of Health-International Centre for Excellence in Research, National Institute for Research in Tuberculosis, Chennai, India.
| | - Hardy Kornfeld
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| |
Collapse
|
11
|
Krause R, Warren CM, Simmons JD, Rebeiro PF, Maruri F, Karim F, Sterling TR, Koethe JR, Leslie A, van der Heijden YF. Failure to decrease HbA1c levels following TB treatment is associated with elevated Th1/Th17 CD4+ responses. Front Immunol 2023; 14:1151528. [PMID: 37313404 PMCID: PMC10258338 DOI: 10.3389/fimmu.2023.1151528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/17/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction The rising global burden of metabolic disease impacts the control of endemic tuberculosis (TB) in many regions, as persons with diabetes mellitus (DM) are up to three times more likely to develop active TB than those without DM. Active TB can also promote glucose intolerance during both acute infection and over a longer term, potentially driven by aspects of the immune response. Identifying patients likely to have persistent hyperglycemia following TB treatment would enable closer monitoring and care, and an improved understanding of underlying immunometabolic dysregulation. Methods We measured the relationship of plasma cytokine levels, T cell phenotypes and functional responses with the change in hemoglobin A1c (HbA1c) before and after treatment of pulmonary TB in a prospective observational cohort in Durban, South Africa. Participants were stratified based on stable/increased HbA1c (n = 16) versus decreased HbA1c (n = 46) levels from treatment initiation to 12 month follow-up. Results CD62 P-selectin was up- (1.5-fold) and IL-10 downregulated (0.85-fold) in plasma among individuals whose HbA1c remained stable/increased during TB treatment. This was accompanied by increased pro-inflammatory TB-specific IL-17 production (Th17). In addition, Th1 responses were upregulated in this group, including TNF-α production and CX3CR1 expression, with decreased IL-4 and IL-13 production. Finally, the TNF-α+ IFNγ+ CD8+ T cells were associated with stable/increased HbA1c. These changes were all significantly different in the stable/increased HbA1c relative to the decreased HbA1c group. Discussion Overall, these data suggest that patients with stable/increased HbA1c had an increased pro-inflammatory state. Persistent inflammation and elevated T cell activity in individuals with unresolved dysglycemia following TB treatment may indicate failure to fully resolve infection or may promote persistent dysglycemia in these individuals, and further studies are needed to explore potential mechanisms.
Collapse
Affiliation(s)
- Robert Krause
- Africa Health Research Institute (AHRI), Durban, South Africa
- College of Health Sciences, School of Laboratory Medicine & Medical Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Christian M. Warren
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Joshua D. Simmons
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Peter F. Rebeiro
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, United States
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Fernanda Maruri
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Farina Karim
- Africa Health Research Institute (AHRI), Durban, South Africa
- College of Health Sciences, School of Laboratory Medicine & Medical Sciences, University of KwaZulu Natal, Durban, South Africa
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Timothy R. Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - John R. Koethe
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
| | - Al Leslie
- Africa Health Research Institute (AHRI), Durban, South Africa
- College of Health Sciences, School of Laboratory Medicine & Medical Sciences, University of KwaZulu Natal, Durban, South Africa
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Yuri F. van der Heijden
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN, United States
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, TN, United States
- The Aurum Institute, Johannesburg, South Africa
| |
Collapse
|
12
|
Adane HT, Howe RC, Wassie L, Magee MJ. 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. J Clin Tuberc Other Mycobact Dis 2023; 31:100368. [PMID: 37122611 PMCID: PMC10130346 DOI: 10.1016/j.jctube.2023.100368] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Background The impact of diabetes mellitus on tuberculosis (TB) treatment outcomes has not been well investigated in most sub-Saharan countries including Ethiopia. The current study aimed to determine the association between diabetes mellitus and unsuccessful TB treatment outcomes among drug-susceptible TB patients treated at selected health facilities in Addis Ababa, Ethiopia. Methods This health facility-based prospective cohort study was conducted at six randomly selected public health centers in Addis Ababa, from August 2020 until November 2021. Clinically diagnosed adult pulmonary and extra pulmonary TB patients were recruited at the time of treatment initiation. A multivariable logistic regression analysis was used to estimate the association between diabetes and unsuccessful TB treatment outcomes. Results Among the total 267 enrolled participants, 9.7% of patients with TB were identified to have diabetes comorbidity. Of patients with diabetes and TB, 9 (34.6%) were newly diagnosed based on glucose test results. Despite an overall high TB treatment success rate (94.0%), more than one-fourth (26.9%) of patients with diabetes had a poor TB treatment outcome (26.9%), which was remarkably higher compared to patients without diabetes (3.7%). In multivariable regression, the adjusted odds of poor TB treatment outcome among those with diabetes was 14.8 (95% CI 3.5 - 62.7) times the odds of poor outcome patients without diabetes. Conclusion Diabetes was significantly associated with increased odds of poor TB treatment outcomes among patients in Addis Ababa, Ethiopia.
Collapse
Affiliation(s)
| | | | - Liya Wassie
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Matthew J. Magee
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Departments of Global Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| |
Collapse
|
13
|
Tarachandani D, Singhal K, Goyal A, Joshi A, Joshi R. Quantum of Stress Hyperglycemia at the Time of Initial Diagnosis of Tuberculosis. Cureus 2023; 15:e36382. [PMID: 37090284 PMCID: PMC10113917 DOI: 10.7759/cureus.36382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 04/25/2023] Open
Abstract
Background India has a high burden of both tuberculosis (TB) and diabetes mellitus (DM). The National TB Elimination Program recommends testing for glycemic status at the initiation of therapy; however, some individuals with elevated sugar levels might have stress hyperglycemia (SH) instead of true DM. Our aim was to perform a longitudinal glycemic assessment of individuals with TB to identify those with true newly diagnosed DM and those with SH. Methods We identified newly diagnosed adults with TB and abstracted information about demography, co-morbidities, disease severity, and glucose-lowering agents. A glycemic assessment was performed at baseline and at the end of six months. Results We included 150 patients with TB, and based on their initial HbA1c values, 82 (54.6%, 95% CI: 46-62%) had dysglycemia (30% had HbA1c levels above 6.4% and 24.6% had values between 5.9% and 6.4%) and 31 (20.7%, 95% CI: 14-18%) had SH. Among individuals with both baseline and follow-up glycemic values, 30% of the individuals previously defined as DM were characterized as SH. The proportion of true SH was 43% (95% CI: 33-60%). Conclusion Most individuals who have dysglycemia at the time of their TB diagnosis have SH. A close follow-up of such individuals will identify those who really require long-term glucose-lowering therapy.
Collapse
Affiliation(s)
- Divya Tarachandani
- Internal Medicine, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
- Internal Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Kritika Singhal
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Abhishek Goyal
- Pulmonary Medicine and Tuberculosis, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ankur Joshi
- Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Rajnish Joshi
- Internal Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| |
Collapse
|
14
|
Kornfeld H, Procter-Gray E, Kumpatla S, Kane K, Li W, Magee MJ, Babu S, Viswanathan V. Longitudinal trends in glycated hemoglobin during and after tuberculosis treatment. Diabetes Res Clin Pract 2023; 196:110242. [PMID: 36627027 DOI: 10.1016/j.diabres.2023.110242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/21/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
AIMS To investigate the impact of pulmonary TB on glycemic status during and after TB treatment, and associations of glycemic trends with antidiabetic therapy and TB outcomes. METHODS Data from two prospective cohort studies of adults in Chennai, India, with pulmonary TB were combined for this analysis. Participants were classified by baseline hemoglobin A1c (A1C) as having normoglycemia (NG; n = 74), prediabetes (pre-DM; n = 110), or diabetes (DM; n = 244). Repeat A1C measurements were performed at TB treatment months 3 and 6, and then 6 and 12 months after TB treatment completion. RESULTS Median A1C at baseline declined after TB treatment initiation in all groups. No baseline NG or pre-DM participants progressed to DM by end of study, while 16.7% of baseline DM participants shifted to pre-DM or NG levels of A1C. In the baseline DM group, rising A1C after the intensive phase of TB treatment was significantly associated with adverse TB outcomes. CONCLUSIONS Incident TB promotes transient glucose elevation but was not conclusively shown to promote chronic dysglycemia. Rising A1C during and after TB treatment may predict unfavorable treatment response in persons presenting with A1C ≥ 6.5 % at the time of TB diagnosis.
Collapse
Affiliation(s)
- Hardy Kornfeld
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, USA.
| | | | | | - Kevin Kane
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Wenjun Li
- Department of Public Health, University of Massachusetts Lowell, Lowell, MA, USA
| | - Matthew J Magee
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Subash Babu
- National Institute for Research in Tuberculosis, International Center for Excellence in Research, National Institutes of Health, Chennai, India
| | | |
Collapse
|
15
|
Kibirige D, Zawedde-Muyanja S, Andia-Biraro I, Olum R, Adakun S, Sekaggya-Wiltshire C, Kimuli I. Diagnostic accuracy of two confirmatory tests for diabetes mellitus in adult Ugandans with recently diagnosed tuberculosis. Ther Adv Infect Dis 2023; 10:20499361231216799. [PMID: 38145193 PMCID: PMC10748612 DOI: 10.1177/20499361231216799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/08/2023] [Indexed: 12/26/2023] Open
Abstract
Objective The optimal confirmatory tests for diabetes mellitus (DM) in patients with tuberculosis (TB) vary across populations. This study aimed to evaluate the performance of two confirmatory tests for DM against the oral glucose tolerance test (OGTT) as the reference test in adult Ugandans with recently diagnosed TB. Methods A total of 232 adult participants receiving TB treatment underwent initial screening for DM with random blood glucose (RBG) measurement. Participants with a RBG level ⩾6.1 mmol/l received additional screening with fasting blood glucose (FBG), laboratory-measured glycated haemoglobin (HbA1c) and an OGTT. Using the latter as the gold standard and reference test, we evaluated the diagnostic accuracy of laboratory-measured HbA1c and FBG. Results Of the 232 participants initially screened for DM using RBG measurement, 117 participants (50.4%) had RBG level ⩾6.1 mmol/l and were scheduled to return for additional blood glucose testing. Of these, 75 (64.1%) participants returned for FBG and HbA1c measurements. A diagnosis of DM was made in 32 participants, corresponding to a prevalence of 13.8% [95% CI 9.9-18.9].The areas under the curve (AUC) for FBG and laboratory-measured HbA1c were 0.69 [95% CI 0.47-0.90] and 0.65 [95% CI 0.43-0.87], respectively. The sensitivity and specificity of a FBG level of ⩾7 mmol/l were 57.1% [95% CI 18.4-90.1] and 74.6% [95% CI 62.5-84.5], respectively, whereas the sensitivity and specificity for laboratory-measured HbA1c of ⩾6.5 mmol/l (48 mmol/mol) were 14.3% [95% CI 0.40-57.9] and 95.3% (86.9-99.0%), respectively. Conclusion FBG may be better than laboratory-measured HbA1c in confirming DM in adult Ugandans with recently diagnosed TB. However, because of the small study sample size, larger studies evaluating the diagnostic utility of these diabetes screening tests in adult Ugandans with TB are needed to confirm these findings.
Collapse
Affiliation(s)
- Davis Kibirige
- Department of Medicine, Uganda Martyrs Hospital Lubaga, Kampala, Uganda
- Non-Communicable Diseases Program, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Uganda Research Unit, P.O. BOX 14130 Kampala, Entebbe +256, Uganda
| | - Stella Zawedde-Muyanja
- The Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Irene Andia-Biraro
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
| | - Susan Adakun
- Adult Tuberculosis Unit, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | | | - Ivan Kimuli
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|
16
|
Williams V, Onwuchekwa C, Vos AG, Grobbee DE, Otwombe K, Klipstein-Grobusch K. Tuberculosis treatment and resulting abnormal blood glucose: a scoping review of studies from 1981 - 2021. Glob Health Action 2022; 15:2114146. [PMID: 36178364 PMCID: PMC9543146 DOI: 10.1080/16549716.2022.2114146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Hyperglycaemia is a risk factor for tuberculosis. Evidence of changes in blood glucose levels during and after tuberculosis treatment is unclear. OBJECTIVE To compile evidence of changes in blood glucose during and after tuberculosis treatment and the effects of elevated blood glucose changes on treatment outcomes in previously normoglycaemic patients. METHODS Original research studies (1980 to 2021) were identified in PubMed, Web of Science, CINAHL and Embase databases. RESULTS Of the 1,277 articles extracted, 14 were included in the final review. All the studies were observational and 50% were prospective. Fasting blood sugar was the most common clinical test (64%), followed by the glycated haemoglobin test and the oral glucose tolerance test (each 50%). Most tests were conducted at baseline and in the third month of treatment. Twelve studies showed that the prevalence of hyperglycaemia in previously normoglycaemic patients decreased from baseline to follow-up and end of treatment. Three studies showed successful treatment outcomes of 64%, 75% and 95%. Patients with hyperglycaemia at baseline were more likely to develop cavitary lung lesions and poor treatment outcomes and had higher post-treatment mortality. There was no difference in outcomes by human immunodeficiency virus (HIV) status. CONCLUSION Elevated blood glucose in normoglycaemic patients receiving treatment for tuberculosis decreased by the end of treatment. Positive HIV status did not affect glucose changes during treatment. Further research is needed to investigate post-treatment morbidity in patients with baseline hyperglycaemia and the effects of HIV on the association between blood glucose and tuberculosis.
Collapse
Affiliation(s)
- Victor Williams
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Monitoring and Evaluation Unit, National Tuberculosis Control Programme, Manzini, Eswatini.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Alinda G Vos
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Diederick E Grobbee
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Kennedy Otwombe
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
17
|
Restrepo BI, Scordo JM, Aguillón-Durán GP, Ayala D, Quirino-Cerrillo AP, Loera-Salazar R, Cruz-González A, Caso JA, Joya-Ayala M, García-Oropesa EM, Salinas AB, Martinez L, Schlesinger LS, Torrelles JB, Turner J. Differential Role of Type 2 Diabetes as a Risk Factor for Tuberculosis in the Elderly versus Younger Adults. Pathogens 2022; 11:pathogens11121551. [PMID: 36558885 PMCID: PMC9784720 DOI: 10.3390/pathogens11121551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/28/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
The elderly are understudied despite their high risk of tuberculosis (TB). We sought to identify factors underlying the lack of an association between TB and type 2 diabetes (T2D) in the elderly, but not adults. We conducted a case-control study in elderly (≥65 years old; ELD) vs. younger adults (young/middle-aged adults (18-44/45-64 years old; YA|MAA) stratified by TB and T2D, using a research study population (n = 1160) and TB surveillance data (n = 8783). In the research study population the adjusted odds ratio (AOR) of TB in T2D was highest in young adults (AOR 6.48) but waned with age becoming non-significant in the elderly. Findings were validated using TB surveillance data. T2D in the elderly (vs. T2D in younger individuals) was characterized by better glucose control (e.g., lower hyperglycemia or HbA1c), lower insulin resistance, more sulphonylureas use, and features of less inflammation (e.g., lower obesity, neutrophils, platelets, anti-inflammatory use). We posit that differences underlying glucose dysregulation and inflammation in elderly vs. younger adults with T2D, contribute to their differential association with TB. Studies in the elderly provide valuable insights into TB-T2D pathogenesis, e.g., here we identified insulin resistance as a novel candidate mechanism by which T2D may increase active TB risk.
Collapse
Affiliation(s)
- Blanca I. Restrepo
- School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
- School of Medicine, South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Edinburg, TX 78541, USA
- Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
- Correspondence: (B.I.R.); (J.T.); Tel.: +1-956-279-3841 (B.I.R.)
| | - Julia M. Scordo
- Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
- Barshop Institute, The University of Texas Health Science Center of San Antonio, San Antonio, TX 78229, USA
| | | | - Doris Ayala
- School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
| | - Ana Paulina Quirino-Cerrillo
- School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
| | - Raúl Loera-Salazar
- Secretaría de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Mexico
| | - America Cruz-González
- Secretaría de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Mexico
| | - Jose A. Caso
- Biology Department, University of Texas Rio Grande Valley, Edinburg, TX 78541, USA
| | - Mateo Joya-Ayala
- School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
- Department of Health and Biomedical Sciences, University of Texas Rio Grande Valley, Edinburg, TX 78541, USA
| | - Esperanza M. García-Oropesa
- Unidad Académica Multidisciplinaria Reynosa-Aztlán, Universidad Autónoma de Tamaulipas Reynosa-Aztlán, Reynosa 88779, Mexico
| | - Alejandra B. Salinas
- School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA 02118, USA
| | - Larry S. Schlesinger
- Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - Jordi B. Torrelles
- Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
| | - Joanne Turner
- Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
- Correspondence: (B.I.R.); (J.T.); Tel.: +1-956-279-3841 (B.I.R.)
| |
Collapse
|
18
|
Makuka GJ, Balandya E, Munseri P. Burden of active pulmonary tuberculosis among patients with diabetes in Dar es Salaam, Tanzania: a cross-sectional study. BMJ Open 2022; 12:e065969. [PMID: 36424102 PMCID: PMC9693890 DOI: 10.1136/bmjopen-2022-065969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES We aimed to determine the prevalence, associated factors and describe the chest radiographic findings for active pulmonary tuberculosis (TB) among patients with diabetes mellitus (DM) attending a diabetic clinic in Tanzania. DESIGN Cross-sectional study. SETTING A diabetic clinic at Temeke Regional Referral Hospital in Dar es salaam, Tanzania. PARTICIPANTS Patients with diabetes. MAIN OUTCOME MEASURES The prevalence and factors associated with active TB in patients with DM. RESULTS Among 623 patients with DM screened, 11 (1.8%); 95% CI 0.9 to 3.1, had active TB of which 6 (54.5%) were GeneXpert positive and 5 (45.5%) were diagnosed based on clinical symptoms and suggestive chest radiographs. The risk of active TB was lower in patients aged 45-64 years compared with age below 45 years (adjusted prevalence ratio (aPR) 0.39, 95% CI (0.11 to 0.42), p=0.001) and in patients with normal chest examination findings compared with patients with crackles or bronchial breathing sounds (aPR 0.02, 95% CI (0.01 to 0.15), p<0.01). The predominant chest radiographic findings were opacification 100% mainly in the upper and mid-lung zones. CONCLUSION Diabetics should be screened for pulmonary TB, particularly among individuals aged 45 years and below with crackles or bronchial breathing on auscultation of the chest. High index of suspicion could help in the early detection and control of TB.
Collapse
Affiliation(s)
- Gerald Jamberi Makuka
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emmanuel Balandya
- Department of Physiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Patricia Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| |
Collapse
|
19
|
Luiz Bezerra1 A, da Silva Rezende Moreira1 A, Isidoro-Gonçalves2 L, F. dos Santos Lara1,3 C, Amorim4 G, C. Silva1,5,6,7 E, Lineu Kritski1 A, Cristina C. Carvalho1,2 A. Clinical, laboratory, and radiographic aspects of patients with pulmonary tuberculosis and dysglycemia and tuberculosis treatment outcomes. J Bras Pneumol 2022; 48:e20210505. [DOI: 10.36416/1806-3756/e20210505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 08/19/2022] [Indexed: 11/09/2022] Open
Abstract
Objective: To analyze the association of dysglycemia with clinical, laboratory, and radiographic characteristics of patients with pulmonary tuberculosis (PTB), as well as with their tuberculo-sis treatment outcomes. Methods: This was a longitudinal study involving 140 patients diag-nosed with PTB (positive cultures for Mycobacterium tuberculosis or positive Xpert MTB/RIF results from sputum samples). Patients were evaluated at diagnosis (M0), after completing the second month of treatment (M2), and at the end of treatment (MEND). At M0, the pati-ents were classified into three groups: normoglycemia+PTB (NGTB); pre-diabetes melli-tus+PTB (PDMTB), and diabetes mellitus+PTB (DMTB), in accordance with glycated hemoglo-bin levels (< 5.7%, 5.7%-6.4%, and = 6.5%, respectively). Treatment outcomes were classified as favorable (cure or treatment completion) and unfavorable (death, loss to follow-up, or treatment failure). Results: In our sample, 76 patients (61.4%) had dysglycemia, 20 of whom (14.3%) had DM at M0. The patients with dysglycemia, in comparison with those in the NGTB group, more frequently presented with positive sputum smear microscopy (94.2% vs. 75.9%; p = 0.003); cavities (80.2% vs. 63.0%; p = 0.03); bilateral lesions (67.4% vs. 46.0%; p = 0.02); and higher median of affected thirds of the lungs (3.0 vs. 2.0; p = 0.03) on chest radiography. No significant differences regarding outcomes were found among the groups, but tuberculosis lethality was higher in the DMTB group than in the PDMTB and NGTB groups (20% vs. 2.2%). Conclusions: PTB patients with dysglycemia had laboratory and radiographic manifestations indicative of more advanced disease, and the risk of death was higher in the DMTB group. These findings reinforce the recommendation for early screening for DM in patients with newly diagnosed tuberculosis in order to reduce the risk of death during treatment.
Collapse
Affiliation(s)
- André Luiz Bezerra1
- 1. Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | | | - Lorrayne Isidoro-Gonçalves2
- 2. Laboratório de Inovações em Terapias, Ensino e Bioprodutos – LITEB – Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro (RJ) Brasil
| | - Carla F. dos Santos Lara1,3
- 1. Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil. 3. Serviço de Tisiologia, Centro Municipal de Saúde de Duque de Caxias, Secretaria Municipal de Duque de Caxias, Duque de Caxias (RJ) Brasil
| | - Gustavo Amorim4
- 4. Department of Biostatistics, Vanderbilt University Medical Center, Nashville (TN) USA
| | - Elisangela C. Silva1,5,6,7
- 1. Programa Acadêmico de Tuberculose, UFRJ, Rio de Janeiro (RJ) Brasil.5. Laboratório de Micobacteriologia Molecular, Hospital Universitário Clementino Fraga Filho, Instituto de Doenças do Tórax – HUCFF-IDT – Faculdade de Medicina, UFRJ, Rio de Janeiro (RJ) Brasil. 6. Laboratório Reconhecer Biologia, Centro de Biociência e Biotecnologia UENF, Campos dos Goytacases (RJ) Brasil. 7. Fundação Saúde do Estado do Rio de Janeiro, Secretaria de Saúde do Estado do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Afrânio Lineu Kritski1
- 1. Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil
| | - Anna Cristina C. Carvalho1,2
- 1. Programa Acadêmico de Tuberculose, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro (RJ) Brasil. 2. Laboratório de Inovações em Terapias, Ensino e Bioprodutos – LITEB – Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro (RJ) Brasil
| |
Collapse
|
20
|
Baluku JB, Nabwana M, Nalunjogi J, Muttamba W, Mubangizi I, Nakiyingi L, Ssengooba W, Olum R, Bongomin F, Andia-Biraro I, Worodria W. Cardiovascular risk factors among people with drug-resistant tuberculosis in Uganda. BMC Cardiovasc Disord 2022; 22:464. [PMID: 36333654 PMCID: PMC9636825 DOI: 10.1186/s12872-022-02889-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background Tuberculosis (TB) and its risk factors are independently associated with cardiovascular disease (CVD). We determined the prevalence and associations of CVD risk factors among people with drug-resistant tuberculosis (DRTB) in Uganda. Methods In this cross-sectional study, we enrolled people with microbiologically confirmed DRTB at four treatment sites in Uganda between July to December 2021. The studied CVD risk factors were any history of cigarette smoking, diabetes mellitus (DM) hypertension, high body mass index (BMI), central obesity and dyslipidaemia. We used modified Poisson regression models with robust standard errors to determine factors independently associated with each of dyslipidaemia, hypertension, and central obesity. Results Among 212 participants, 118 (55.7%) had HIV. Overall, 196 (92.5%, 95% confidence interval (CI) 88.0-95.3) had ≥ 1 CVD risk factor. The prevalence; 95% CI of individual CVD risk factors was: dyslipidaemia (62.5%; 55.4–69.1), hypertension (40.6%; 33.8–47.9), central obesity (39.3%; 32.9–46.1), smoking (36.3%; 30.1–43.1), high BMI (8.0%; 5.0–12.8) and DM (6.5%; 3.7–11.1). Dyslipidaemia was associated with an increase in glycated haemoglobin (adjusted prevalence ratio (aPR) 1.14, 95%CI 1.06–1.22). Hypertension was associated with rural residence (aPR 1.89, 95% CI 1.14–3.14) and previous history of smoking (aPR 0.46, 95% CI 0.21–0.98). Central obesity was associated with increasing age (aPR 1.02, 95%CI 1.00–1.03), and elevated diastolic blood pressure (aPR 1.03 95%CI 1.00–1.06). Conclusion There is a high prevalence of CVD risk factors among people with DRTB in Uganda, of which dyslipidaemia is the commonest. We recommend integrated services for identification and management of CVD risk factors in DRTB.
Collapse
|
21
|
Baluku JB, Ronald O, Bagasha P, Okello E, Bongomin F. Prevalence of cardiovascular risk factors in active tuberculosis in Africa: a systematic review and meta-analysis. Sci Rep 2022; 12:16354. [PMID: 36175540 PMCID: PMC9523035 DOI: 10.1038/s41598-022-20833-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 09/19/2022] [Indexed: 11/25/2022] Open
Abstract
People with tuberculosis (TB) are at risk of major adverse cardiovascular events. We estimated the prevalence of cardiovascular risk (CVR) factors among people with active TB in Africa. This was a systematic review and meta-analysis of studies from Africa. We searched EMBASE, MEDLINE through PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, mRCTs, Clinical trials.gov, and International Clinical Trials Registry Platform from inception to 31st December 2021. Among 110 eligible studies, 79 (238,316 participants) were included in the meta-analysis for smoking, 67 (52,793 participants) for current alcohol use, 30 (31,450 participants) for hazardous alcohol use, 51 (37,879 participants) for diabetes mellitus (DM), 19 (18,211 participants) for hypertension and 18 (13,910 participants) for obesity. The pooled prevalence was 26.0% (95% confidence interval 22.0–29.0) for smoking, 30.0% (25.0–35.0) for any current alcohol use, 21.0% (17.0–26.0) for hazardous alcohol use, 14.0% (9.0–18.0) for hypertension, 7.0% (6.0–9.0) for DM, and 4.0% (2.0–5.0) for obesity. Cost-effective strategies are needed to screen for CVR factors among people with active TB in Africa.
Collapse
Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, PO Box 26343, Kampala, Uganda. .,Makerere University Lung Institute, Kampala, Uganda.
| | - Olum Ronald
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Peace Bagasha
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Felix Bongomin
- Department of Internal Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| |
Collapse
|
22
|
Byashalira K, Chamba N, Alkabab Y, Mbelele P, Mpolya E, Ntinginya N, Shayo PJ, Ramaiya KL, Lillebaek T, Heysell SK, Mmbaga BT, Bygbjerg IC, Mpagama S, Christensen DL. Impact of early diagnosis of impaired glucose regulation in tuberculosis: Comparison of clinical outcomes in people with tuberculosis in Tanzania. Trop Med Int Health 2022; 27:815-822. [DOI: 10.1111/tmi.13806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kenneth Byashalira
- Kilimanjaro Christian Medical University College Moshi Tanzania
- Kibong'oto Infectious Diseases Hospital Kilimanjaro Tanzania
| | - Nyasatu Chamba
- Kilimanjaro Christian Medical University College Moshi Tanzania
- Kilimanjaro Christian Medical Centre Moshi Tanzania
| | - Yosra Alkabab
- Division of Infectious Diseases and International Health University of Virginia USA
| | - Peter Mbelele
- Kibong'oto Infectious Diseases Hospital Kilimanjaro Tanzania
| | - Emmanuel Mpolya
- Department of Global Health and Bio‐Medical Sciences Nelson Mandela African Institution of Science
| | - Nyanda Ntinginya
- National Institute of Medical Research, Mbeya Medical Research Centre Mbeya Tanzania
| | | | | | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut Copenhagen Denmark
- Global Health Section, Department of Public Health University of Copenhagen Denmark
| | - Scott K. Heysell
- Division of Infectious Diseases and International Health University of Virginia USA
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Medical University College Moshi Tanzania
- Kilimanjaro Christian Medical Centre Moshi Tanzania
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre Moshi Tanzania
| | - Ib C. Bygbjerg
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut Copenhagen Denmark
| | - Stellah Mpagama
- Kilimanjaro Christian Medical University College Moshi Tanzania
- Kibong'oto Infectious Diseases Hospital Kilimanjaro Tanzania
| | - Dirk L. Christensen
- Global Health Section, Department of Public Health University of Copenhagen Denmark
| | | |
Collapse
|
23
|
Joshi R, Behera D, Di Tanna GL, Ameer MA, Yakubu K, Praveen D. Integrated Management of Diabetes and Tuberculosis in Rural India - Results From a Pilot Study. Front Public Health 2022; 10:766847. [PMID: 35619802 PMCID: PMC9127505 DOI: 10.3389/fpubh.2022.766847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/21/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction The World Health Organization and International Union against Tuberculosis (TB) recommends screening patients with TB for Diabetes Mellitus (DM) at the initiation of treatment. There are few pilot studies which screen TB patients for DM, but none of them have documented the feasibility of managing TB patients with DM in the Indian healthcare setting. Operational research is needed to determine the best way to manage individuals with both conditions. This pilot study aimed to develop, and field test an integrated, multidisciplinary program addressing the management of individuals with TB and DM and other associated chronic conditions in the Indian primary healthcare setting. Methods This pilot study used a randomized controlled trial design with mixed-methods evaluation and was conducted in Guntur district of Andhra Pradesh, a southern state of India. All the 120 patients newly diagnosed with TB from 10 participating villages were screened for DM and associated cardiovascular risk factors. Non-physician health workers were trained to follow-up patients for a period of 8 months to encourage treatment adherence, monitor treatment response including blood glucose levels and provide lifestyle advice. Results The intervention was well-accepted by the providers and patients. However, there were no statistically significant variations observed for mean blood glucose levels (mean [SD]: 5.3 [−23.3 to 33.8]) of patients for both intervention and control group participants in this feasibility study. Awareness about diabetes and tuberculosis comorbidity and cardiovascular risk increased among the non-physician health workers in the intervention arm of the study. Discussion The co-management of TB-DM is acceptable to both the health providers and patients. With appropriate training, availability of infrastructure and planned intervention implementation, it is feasible to co-manage TB-DM within the existing primary health care system in India.
Collapse
Affiliation(s)
- Rohina Joshi
- School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Health Systems Science, The George Institute for Global Health, New Delhi, India
| | | | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Mohammed Abdul Ameer
- Health Systems Science, The George Institute for Global Health, New Delhi, India
| | - Kenneth Yakubu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Devarsetty Praveen
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.,Health Systems Science, The George Institute for Global Health, New Delhi, India.,Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
24
|
Jørgensen A, Lorentsson HJN, Huber FG, Jensen SG, Bjorn-Mortensen K, Ravn P. Dysglycaemia among tuberculosis patients without known diabetes in a low-endemic setting. ERJ Open Res 2022; 8:00629-2021. [PMID: 35415185 PMCID: PMC8995539 DOI: 10.1183/23120541.00629-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022] Open
Abstract
There is increasing evidence that diabetes mellitus is an important risk factor for tuberculosis (TB) and might affect TB-disease presentation as well as treatment response [1]. The hypothesis is that an impaired immune response in persons with diabetes mellitus facilitates infection with Mycobacterium tuberculosis and/or progression to TB, and reversely, M. tuberculosis infection may affect glycaemic control [2, 3]. Although the exact causality is unknown, this association between TB and diabetes mellitus is ominous, as the explosive rise in diabetes mellitus worldwide witnessed over the last decades could potentially counteract the positive effect of TB control efforts. With a high prevalence of dysglycaemia (29.1%) among tuberculosis patients without previously known diabetes, this study highlights the importance of comanagement of tuberculosis and diabetes, even in a low-endemic settinghttps://bit.ly/3Gj0gmN
Collapse
|
25
|
Obels I, Ninsiima S, Critchley JA, Huangfu P. Tuberculosis risk among people with diabetes mellitus in Sub-Saharan Africa: a systematic review. Trop Med Int Health 2022; 27:369-386. [PMID: 35146851 PMCID: PMC9303199 DOI: 10.1111/tmi.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objectives People with diabetes mellitus (DM) have a higher tuberculosis (TB) risk, but the evidence from sub‐Saharan Africa (SSA) was scarce until recently and not included in earlier global summaries. Therefore, this systematic review aims to determine the risk of active TB disease among people with DM in SSA and whether HIV alters this association. Methods Medline, Embase, CINAHL, Web of Science, Global Health and African Index Medicus were searched between January 1980 and February 2021. Cohort, case‐control and cross‐sectional studies from SSA, which assessed the association between DM and active TB, were included if adjusted for age. Two researchers independently assessed titles, abstracts, full texts, extracted data and assessed the risk of bias. Estimates for the association between DM and TB were summarised using a random effects meta‐analysis. PROSPERO: CRD42021241743. Results Nine eligible studies were identified, which reported on 110,905 people from 5 countries. Individual study odds ratios (OR) of the TB–DM association ranged from 0.88 (95% CI 0.17–4.58) to 10.7 (95% CI 4.5–26). The pooled OR was 2.77 (95% CI 1.90–4.05). High heterogeneity was reduced in sensitivity analysis (from I2 = 57% to I2 = 6.9%), by excluding one study which ascertained DM by HbA1c. Risk of bias varied widely between studies, especially concerning the way in which DM status was determined. Conclusions There is a strong positive association between DM and active TB in SSA. More research is needed to determine whether HIV, a key risk factor for TB in SSA, modifies this relationship.
Collapse
Affiliation(s)
- Ilja Obels
- Master's student Biomedical Sciences, Radboud University Nijmegen, The Netherlands
| | - Sandra Ninsiima
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Julia A Critchley
- Population Health Research Institute, St George's, University of London, UK
| | - Peijue Huangfu
- Population Health Research Institute, St George's, University of London, UK
| |
Collapse
|
26
|
Naidoo A, Naidoo K, Padayatchi N, Dooley KE. Use of integrase inhibitors in HIV-associated tuberculosis in high-burden settings: implementation challenges and research gaps. Lancet HIV 2022; 9:e130-e138. [PMID: 35120633 PMCID: PMC8970050 DOI: 10.1016/s2352-3018(21)00324-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 02/03/2023]
Abstract
People living with HIV have a higher risk of developing tuberculosis, and tuberculosis is one of the leading causes of death among people living with HIV globally. Treating HIV and tuberculosis concurrently has morbidity and mortality benefits. However, HIV and tuberculosis co-treatment is challenging due to drug-drug interactions, overlapping toxicities, tuberculosis-associated immune reconstitution syndrome, and concerns for treatment failure or drug resistance. Drug-drug interactions between antiretrovirals and tuberculosis drugs are driven mainly by the rifamycins (for example, the first-line tuberculosis drug rifampicin), and dose adjustments or drug switches during co-treatment are commonly required. Several implementation challenges and research gaps exist when combining the integrase strand transfer inhibitors (INSTIs), highly potent antiretroviral drugs recommended as first-line treatment of HIV, and drugs used for the treatment and prevention of tuberculosis. Ongoing and planned studies will address some critical questions on the use of INSTIs in settings with a high tuberculosis burden, including dosing of dolutegravir, bictegravir, and cabotegravir when used with the rifamycins for both tuberculosis treatment and prevention. Failure, in the past, to include people with tuberculosis in HIV clinical treatment trials has been responsible for some of the research gaps still evident for informing optimisation of HIV and tuberculosis co-treatment.
Collapse
|
27
|
Calderon RI, Arriaga MB, Aliaga JG, Barreda NN, Sanabria OM, Barreto-Duarte B, Franco JPD, Lecca L, Andrade BB, Carvalho ACC, Kritski AL. Persistent dysglycemia is associated with unfavorable treatment outcomes in patients with pulmonary tuberculosis from Peru. Int J Infect Dis 2022; 116:293-301. [PMID: 35033658 DOI: 10.1016/j.ijid.2022.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Dysglycemia (i.e., prediabetes or diabetes) on patients with tuberculosis (PWTB) was associated with increased odds of mortality and treatment failure. Whether such association holds when dysglycemia is transient or persistent is unknown. Here we tested the association between persistent dysglycemia (PD) during anti-TB treatment and unfavorable treatment outcomes in PWTB from Lima, Peru. METHODS PWTB enrolled between February and November 2017 were followed for 24-months. Dysglycemia was measured by fasting glucose and HbA1c at baseline, 2nd-and 6th-month of TB treatment. PD was defined as dysglycemia detected in two different visits. The association between PD and unfavorable TB treatment outcome was evaluated by logistic regression. RESULTS Among 125 PWTB, PD prevalence was 29.6%. PD was associated with more lung lesion types, higher bacillary loads, low hemoglobin and high body mass index (BMI). Unfavorable TB treatment outcome was associated with older age, higher BMI, more lung lesion types and PD. After adjusting for age, hemoglobin levels, smoking and smear grade, PD was independently associated with unfavorable treatment (aOR: 6.1; 95%CI: 1.9-19.6). CONCLUSION Persistent dysglycemia is significantly associated with higher odds of unfavorable TB treatment outcomes. Dysglycemia control trough anti-TB treatment gives the opportunity to introduce appropriate interventions to TB management.
Collapse
Affiliation(s)
- Roger I Calderon
- Socios En Salud Sucursal Peru, Lima 15001, Peru; Programa Acadêmico de Tuberculose. Faculdade de Medicina. Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-590, Brazil; Grupo de Investigación en Bioquímica y Biología Sintética, Universidad Nacional Federico Villarreal, Lima, Peru.
| | - María B Arriaga
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia 40269-710, Brazil; Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Bahia 40110-100, Brazil; Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil; Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Bahia 40210-320, Brazil.
| | - Juan G Aliaga
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil; Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil.
| | - Nadia N Barreda
- Department of Global Health and Social Medicine. Harvard Medical School. Boston, United States of America.
| | | | - Beatriz Barreto-Duarte
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
| | - João Pedro Duarte Franco
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil; Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil.
| | - Leonid Lecca
- Socios En Salud Sucursal Peru, Lima 15001, Peru; Department of Global Health and Social Medicine. Harvard Medical School. Boston, United States of America.
| | - Bruno B Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.
| | - Anna Cristina Calçada Carvalho
- Curso de Medicina, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil; Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA; Laboratório de Inovações em Terapias, Ensino e Bioprodutos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro 21040-900, Brazil.
| | - Afrânio L Kritski
- Programa Acadêmico de Tuberculose. Faculdade de Medicina. Universidade Federal do Rio de Janeiro, Rio de Janeiro 21941-590, Brazil.
| |
Collapse
|
28
|
Koesoemadinata RC, McAllister SM, Soetedjo NNM, Santoso P, Ruslami R, Damayanti H, Rahmadika N, Alisjahbana B, van Crevel R, Hill PC. Educational counselling of patients with combined TB and diabetes mellitus: a randomised trial. Public Health Action 2021; 11:202-208. [PMID: 34956849 DOI: 10.5588/pha.21.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/28/2021] [Indexed: 11/10/2022] Open
Abstract
SETTING Newly diagnosed pulmonary TB with diabetes mellitus (DM) comorbidity attending clinics in Bandung City, Indonesia. OBJECTIVE To describe the effect of educational counselling on patients' knowledge about TB (transmission, treatment, risk factors) and DM (symptoms, treatment, complications, healthy lifestyle), adherence to medication, and to assess characteristics associated with knowledge. DESIGN All patients received counselling and were then randomised to either structured education on TB-DM, combined with clinical monitoring and medication adjustment (intervention arm), or routine care (control arm). Knowledge and adherence were assessed using a questionnaire. RESULTS Baseline and 6-month questionnaires were available for 108 of 150 patients randomised (60/76 in the intervention arm and 48/74 in the control arm). Patients knew less about DM than about TB. There was no significant difference in the proportion with knowledge improvement at 6 months, both for TB (difference of differences 14%; P = 0.20) or for DM (10%; P = 0.39) between arms. Intervention arm patients were more likely to adhere to taking DM medication, with fewer patients reporting ever missing oral DM drugs than those in the control arm (23% vs. 48%; P = 0.03). Higher education level was associated with good knowledge of both TB and DM. CONCLUSIONS Structured education did not clearly improve patients' knowledge. It was associated with better adherence to DM medication, but this could not be attributed to education alone. More efforts are needed to improve patients' knowledge, especially regarding DM.
Collapse
Affiliation(s)
- R C Koesoemadinata
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - S M McAllister
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago Medical School, Dunedin, New Zealand
| | - N N M Soetedjo
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - P Santoso
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R Ruslami
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - H Damayanti
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - N Rahmadika
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia
| | - B Alisjahbana
- Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/Dr Hasan Sadikin General Hospital, Bandung, Indonesia
| | - R van Crevel
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - P C Hill
- Department of Preventive and Social Medicine, Centre for International Health, University of Otago Medical School, Dunedin, New Zealand
| |
Collapse
|
29
|
Foe-Essomba JR, Kenmoe S, Tchatchouang S, Ebogo-Belobo JT, Mbaga DS, Kengne-Ndé C, Mahamat G, Kame-Ngasse GI, Noura EA, Mbongue Mikangue CA, Feudjio AF, Taya-Fokou JB, Touangnou-Chamda SA, Nayang-Mundo RA, Nyebe I, Magoudjou-Pekam JN, Yéngué JF, Djukouo LG, Demeni Emoh CP, Tazokong HR, Bowo-Ngandji A, Lontchi-Yimagou E, Kaiyven AL, Donkeng Donfack VF, Njouom R, Mbanya JC, Mbacham WF, Eyangoh S. Diabetes mellitus and tuberculosis, a systematic review and meta-analysis with sensitivity analysis for studies comparable for confounders. PLoS One 2021; 16:e0261246. [PMID: 34890419 PMCID: PMC8664214 DOI: 10.1371/journal.pone.0261246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/28/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction Meta-analyses conducted so far on the association between diabetes mellitus (DM) and the tuberculosis (TB) development risk did not sufficiently take confounders into account in their estimates. The objective of this systematic review was to determine whether DM is associated with an increased risk of developing TB with a sensitivity analyses incorporating a wider range of confounders including age, gender, alcohol consumption, smoke exposure, and other comorbidities. Methods Pubmed, Embase, Web of Science and Global Index Medicus were queried from inception until October 2020. Without any restriction to time of study, geographical location, and DM and TB diagnosis approaches, all observational studies that presented data for associations between DM and TB were included. Studies with no abstract or complete text, duplicates, and studies with wrong designs (review, case report, case series, comment on an article, and editorial) or populations were excluded. The odds ratios (OR) and their 95% confidence intervals were estimated by a random-effect model. Results The electronic and manual searches yielded 12,796 articles of which 47 were used in our study (23 case control, 14 cross-sectional and 10 cohort studies) involving 503,760 cases (DM or TB patients) and 3,596,845 controls. The size of the combined effect of TB risk in the presence of DM was OR = 2.3, 95% CI = [2.0–2.7], I2 = 94.2%. This statistically significant association was maintained in cohort (OR = 2.0, CI 95% = [1.5–2.4], I2 = 94.3%), case control (OR = 2.4, CI 95% = [2.0–2.9], I2 = 93.0%) and cross-sectional studies (OR = 2.5, CI 95% = [1.8–3.5], I2 = 95.2%). The association between DM and TB was also maintained in the sensitivity analysis including only studies with similar proportions of confounders between cases and controls. The substantial heterogeneity observed was mainly explained by the differences between geographic regions. Conclusions DM is associated with an increased risk of developing latent and active TB. To further explore the role of DM in the development of TB, more investigations of the biological mechanisms by which DM increases the risk of TB are needed. Review registration PROSPERO, CRD42021216815.
Collapse
Affiliation(s)
- Joseph Rodrigue Foe-Essomba
- Camdiagnostic, Ministry of Scientific Research and Innovation, Yaounde, Cameroon
- Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde, Cameroon
- Department of Mycobacteriology, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | - Sebastien Kenmoe
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | | | - Jean Thierry Ebogo-Belobo
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | | | - Cyprien Kengne-Ndé
- Evaluation and Research Unit, National AIDS Control Committee, Yaounde, Cameroon
| | - Gadji Mahamat
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Ginette Irma Kame-Ngasse
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Efietngab Atembeh Noura
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | | | | | | | | | | | - Inès Nyebe
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | | | | | | | | | | | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Eric Lontchi-Yimagou
- Laboratory for Molecular Medicine and Metabolism, The University of Yaounde I, Yaounde, Cameroon
| | - Afi Leslie Kaiyven
- Institute of Biomedical and Clinical Research, University of Exeter, Exeter, United Kingdom
| | | | - Richard Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
| | - Jean Claude Mbanya
- Laboratory for Molecular Medicine and Metabolism, The University of Yaounde I, Yaounde, Cameroon
| | | | - Sara Eyangoh
- Department of Mycobacteriology, Centre Pasteur of Cameroon, Yaounde, Cameroon
- * E-mail:
| |
Collapse
|
30
|
Alkabab YMA, Biswas S, Ahmed S, Paul K, Nagajyothi J, Banu S, Heysell S. Differentiating transient from persistent diabetic range hyperglycemia in a cohort of people completing tuberculosis treatment in Dhaka, Bangladesh. PLoS One 2021; 16:e0260389. [PMID: 34813631 PMCID: PMC8610235 DOI: 10.1371/journal.pone.0260389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 11/08/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In recent non-pandemic periods, tuberculosis (TB) has been the leading killer worldwide from a single infectious disease. Patients with DM are three times more likely to develop active TB and poor treatment outcomes. Single glycemic measurements at TB diagnosis may inaccurately diagnose or mischaracterize DM severity. Data are limited regarding glycemic dynamics from TB diagnosis through treatment. METHODS Prospective study of glycemia dynamics in response to TB treatment measured glycosylated haemoglobin (HbA1c) in patients presenting to TB screening centres in Bangladesh to determine the prevalence and risk factors of hyperglycemia before and at TB treatment completion. RESULTS 429 adults with active TB disease were enrolled and divided into groups based on history of DM and initial HbA1c range: normoglycemia, prediabetes, and DM. DM was diagnosed in 37%. At treatment completion,14(6%) patients from the normoglycemia and prediabetes groups had HbA1c>6.5%, thus increasing the prevalence of DM to 39%. The number needed to screen to diagnose one new case of DM at TB diagnosis was 5.7 and 16 at treatment completion in the groups without DM. Weight gain>5% at treatment completion significantly increased the risk of hyperglycemia in the groups without DM at TB diagnosis (95% CI 1.23-26.04, p<0.05). CONCLUSION HbA1c testing prior to and at TB treatment completion found a high prevalence of prediabetes and DM, including a proportion found at treatment completion and commonly in people with a higher percentage of weight gain. Further longitudinal research is needed to understand the effects of TB disease and treatment on insulin resistance and DM complications.
Collapse
Affiliation(s)
- Yosra M. A. Alkabab
- University of Virginia Medical Center, Division of Infectious diseases and International Health, Department of Medicine, Charlottesville, VA, United States of America
| | - Samanta Biswas
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Enteric and Respiratory Infections, Infectious Diseases Division, Dhaka, Bangladesh
| | - Shahriar Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Enteric and Respiratory Infections, Infectious Diseases Division, Dhaka, Bangladesh
| | - Kishor Paul
- The Kirby Institute, University of New South Wales, Surveillance Evaluation Research Program, Kensington, NSW, Australia
| | - Jyothi Nagajyothi
- Center for Discovery and Innovation, Hackensack University Medical Center, Nutley, New Jersey, United States of America
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Enteric and Respiratory Infections, Infectious Diseases Division, Dhaka, Bangladesh
| | - Scott Heysell
- University of Virginia Medical Center, Division of Infectious diseases and International Health, Department of Medicine, Charlottesville, VA, United States of America
| |
Collapse
|
31
|
Arriaga MB, Araújo-Pereira M, Barreto-Duarte B, Nogueira B, Freire MVCNS, Queiroz ATL, Rodrigues MMS, Rocha MS, Souza AB, Spener-Gomes R, Carvalho ACC, Figueiredo MC, Turner MM, Durovni B, Lapa-E-Silva JR, Kritski AL, Cavalcante S, Rolla VC, Cordeiro-Santos M, Sterling TR, Andrade BB. The Effect of Diabetes and Prediabetes on Anti-tuberculosis Treatment Outcomes: A Multi-center Prospective Cohort Study. J Infect Dis 2021; 225:617-626. [PMID: 34651642 DOI: 10.1093/infdis/jiab427] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/23/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND It is unclear whether diabetes or prediabetes affect unfavorable treatment outcomes and death in people with tuberculosis (PWTB). METHODS Culture-confirmed drug-susceptible PWTB, enrolled in Regional Prospective Observational Research in Tuberculosis (RePORT)-Brazil between 2015-2019 (n=643) were stratified based on glycemic status according to baseline glycated hemoglobin. Unfavorable TB outcome was defined as treatment failure or modification, recurrence or death; favorable outcome was cure or treatment completion. We corroborated the findings using data from PWTB reported to the Brazilian National System of Diseases Notification (SINAN) during 2015-2019 (n=20,989). Logistic regression models evaluated associations between glycemic status and outcomes. RESULTS In both cohorts, in univariate analysis, unfavorable outcomes were more frequently associated with smoking, illicit drug use and HIV infection. Diabetes, but not prediabetes, was associated with unfavorable outcomes in the RePORT-Brazil (adjusted Relative Risk [aRR]: 2.45, p<0.001) and SINAN (aRR: 1.76, p<0.001) cohorts. Furthermore, diabetes was associated with high risk of death (during TB treatment) in both RePORT-Brazil (aRR:2.16, p=0.040) and SINAN (aRR:1.93, p= 0.001). CONCLUSION Diabetes was associated with an increased risk of unfavorable outcomes and mortality in Brazilian PWTB. Interventions to improve tuberculosis treatment outcomes in persons with diabetes are needed.
Collapse
Affiliation(s)
- María B Arriaga
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Mariana Araújo-Pereira
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Beatriz Barreto-Duarte
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil
| | - Betânia Nogueira
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.,Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil
| | | | - Artur T L Queiroz
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Moreno M S Rodrigues
- Laboratório de Análise e Visualização de Dados, Fundação Oswaldo Cruz, Porto Velho, Brazil
| | - Michael S Rocha
- Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Instituto Brasileiro para Investigação da Tuberculose, Fundação José Silveira, Salvador, Brazil
| | - Alexandra B Souza
- Fundação Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil
| | - Renata Spener-Gomes
- Fundação Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Universidade Federal do Amazonas, Manaus, Brazil
| | - Anna Cristina C Carvalho
- Programa Acadêmico de Tuberculose da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.,Laboratório de Inovações em Terapias, Ensino e Bioprodutos (LITEB), Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Brazil
| | - Marina C Figueiredo
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Megan M Turner
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Betina Durovni
- Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro, Brazil
| | - José R Lapa-E-Silva
- Programa Acadêmico de Tuberculose da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Afrânio L Kritski
- Programa Acadêmico de Tuberculose da Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Valeria C Rolla
- Laboratório de Pesquisa Clínica em Micobacteriose, Instituto Nacional de Infectologia Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil
| | - Marcelo Cordeiro-Santos
- Fundação Medicina Tropical Dr Heitor Vieira Dourado, Manaus, Brazil.,Programa de Pós-Graduação em Medicina Tropical, Universidade do Estado do Amazonas, Manaus, Brazil.,Universidade Nilton Lins, Manaus, Brazil
| | - Timothy R Sterling
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Bruno B Andrade
- Laboratório de Inflamação e Biomarcadores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Multinational Organization Network Sponsoring Translational and Epidemiological Research (MONSTER) Initiative, Salvador, Brazil.,Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil.,Curso de Medicina, Universidade Salvador (UNIFACS), Salvador, Brazil.,Curso de Medicina, Escola Bahiana de Medicina e Saúde Pública (EBMSP), Salvador, Brazil.,Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Bacteriology and Bioassay Laboratory, National Institute of Infectious Diseases Evandro Chagas, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | | |
Collapse
|
32
|
Antonio-Arques V, Franch-Nadal J, Caylà JA. Diabetes and tuberculosis: A syndemic complicated by COVID-19. ACTA ACUST UNITED AC 2021; 157:288-293. [PMID: 34541325 PMCID: PMC8433042 DOI: 10.1016/j.medcle.2021.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
Tuberculosis (TB) is the leading cause of infectious mortality in the world, affecting mainly developing countries (DC), while diabetes (DM) is one of the most prevalent chronic diseases. This review analyzes the fact that diabetes is currently an important risk factor for developing TB, also presenting more complicated TB, more relapses and higher mortality. The DCs and the fourth world of the large cities are those with the highest incidence of TB and an increase in DM, which will make it difficult to control tuberculosis disease. At the same time, the COVID-19 pandemic is complicating the management of both diseases due to the difficulty of access to control and treatment and the worsening of socioeconomic inequalities. It is necessary to establish a bidirectional screening for TB and DM and promote recommendations for the joint management of both diseases.
Collapse
Affiliation(s)
- Violeta Antonio-Arques
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain.,Equip d'Atenció Primària (EAP) Bordeta Magòria, Institut Català de la Salut, Barcelona, Spain
| | - Josep Franch-Nadal
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain.,Equip d'Atenció Primària (EAP) Raval Sud - Drassanes, Institut Català de la Salut, Barcelona, Spain
| | - Joan A Caylà
- Fundación de la Unidad de Investigación en Tuberculosis de Barcelona, Barcelona, Spain
| |
Collapse
|
33
|
Kubiak RW, Kratz M, Motala AA, Galagan S, Govere S, Brown ER, Moosa MYS, Drain PK. Clinic-based diabetes screening at the time of HIV testing and associations with poor clinical outcomes in South Africa: a cohort study. BMC Infect Dis 2021; 21:789. [PMID: 34376173 PMCID: PMC8353828 DOI: 10.1186/s12879-021-06473-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 07/09/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND HIV clinical care programs in high burden settings are uniquely positioned to facilitate diabetes diagnosis, which is a major challenge. However, in sub-Saharan Africa, data on the burden of diabetes among people living with HIV (PLHIV) and its impact on HIV outcomes is sparse. METHODS We enrolled adults presenting for HIV testing at an outpatient clinic in Durban. Those who tested positive for HIV-infection were screened for diabetes using a point-of-care hemoglobin A1c (HbA1c) test. We used log-binomial, Poisson, and Cox proportional hazard models adjusting for confounders to estimate the relationship of diabetes (HbA1c ≥ 6.5%) with the outcomes of HIV viral suppression (< 50 copies/mL) 4-8 months after antiretroviral therapy initiation, retention in care, hospitalization, tuberculosis, and death over 12 months. RESULTS Among 1369 PLHIV, 0.5% (n = 7) reported a prior diabetes diagnosis, 20.6% (95% CI 18.5-22.8%, n = 282) screened positive for pre-diabetes (HbA1c 5.7-6.4%) and 3.5% (95% CI 2.7-4.6%, n = 48) for diabetes. The number needed to screen to identify one new PLHIV with diabetes was 46.5 persons overall and 36.5 restricting to those with BMI ≥ 25 kg/m2. Compared to PLHIV without diabetes, the risk of study outcomes among those with diabetes was not statistically significant, although the adjusted hazard of death was 1.79 (95% CI 0.41-7.87). CONCLUSIONS Diabetes and pre-diabetes were common among adults testing positive for HIV and associated with death. Clinic-based diabetes screening could be targeted to higher risk groups and may improve HIV treatment outcomes.
Collapse
Affiliation(s)
- Rachel W Kubiak
- Department of Epidemiology, Health Sciences Building, University of Washington, Seattle, WA, USA.
| | - Mario Kratz
- Department of Epidemiology, Health Sciences Building, University of Washington, Seattle, WA, USA
- Cancer Prevention Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Sean Galagan
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Elisabeth R Brown
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Mahomed-Yunus S Moosa
- Department of Infectious Diseases, University of KwaZulu-Natal, Durban, South Africa
| | - Paul K Drain
- Department of Epidemiology, Health Sciences Building, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
34
|
Liu Q, You N, Pan H, Shen Y, Lu P, Wang J, Lu W, Zhu L, Martinez L. Glycemic Trajectories and Treatment Outcomes of Patients with Newly Diagnosed Tuberculosis: A Prospective Study in Eastern China. Am J Respir Crit Care Med 2021; 204:347-356. [PMID: 33705666 DOI: 10.1164/rccm.202007-2634oc] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rationale: Patients with newly diagnosed tuberculosis often have inconsistent glycemic measurements during and after treatment. Distinct glycemic trajectories after the diagnosis of tuberculosis are not well characterized, and whether patients with stress hyperglycemia have poor treatment outcomes is not known.Objectives: To identify distinct glycemic trajectories from the point of tuberculosis diagnosis to the posttreatment period and to assess the relationship between glycemic trajectories and tuberculosis treatment outcomes.Methods: Patients with newly diagnosed, drug-susceptible tuberculosis and with at least three fasting plasma glucose tests at tuberculosis diagnosis and during the third and sixth month of treatment were identified and included from Jiangsu Province, China. Patients were also given an additional fasting plasma glucose test at 2 and 4 months after treatment.Measurements and Main Results: Several distinct glycemic trajectories from the point of tuberculosis diagnosis to the posttreatment period were found, including consistently normal glycemic testing results (43%), transient hyperglycemia (24%), erratic glycemic instability (12%), diabetes (16%), and consistent hyperglycemia without diabetes (6%). Compared with participants with a consistently normal glycemic trajectory, patients with transient hyperglycemia were more likely to experience treatment failure (adjusted odds ratio [AOR], 4.20; 95% confidence interval [CI], 1.57-11.25; P = 0.004) or erratic glycemic instability (AOR, 5.98; 95% CI, 2.00-17.87; P = 0.001). Patients living with diabetes also had a higher risk of experiencing treatment failure (AOR, 6.56; 95% CI, 2.22-19.35; P = 0.001), and this was modified by glycemic control and metformin use.Conclusions: Among patients with tuberculosis without diabetes, glycemic changes were common and may represent an important marker for patient response to tuberculosis treatment.
Collapse
Affiliation(s)
- Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, People's Republic of China.,Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Nannan You
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, People's Republic of China.,The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, People's Republic of China
| | - Hongqiu Pan
- Department of Tuberculosis, The Third People's Hospital of Zhenjiang Affiliated to Jiangsu University, Zhenjiang, People's Republic of China
| | - Ye Shen
- Department of Epidemiology and Biostatistics, School of Public Health, University of Georgia, Athens, Georgia; and
| | - Peng Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, People's Republic of China
| | - Jianming Wang
- Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing, People's Republic of China
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, People's Republic of China
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, People's Republic of China
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, Massachusetts
| |
Collapse
|
35
|
Shayo FK, Shayo SC. Readiness of healthcare facilities with tuberculosis services to manage diabetes mellitus in Tanzania: A nationwide analysis for evidence-informed policy-making in high burden settings. PLoS One 2021; 16:e0254349. [PMID: 34252144 PMCID: PMC8274870 DOI: 10.1371/journal.pone.0254349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 06/24/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Double disease burden such as Tuberculosis and Diabetes mellitus comorbidity is evident and on rising especially in high burden settings such as Tanzania. There is limited information about the availability of tuberculosis/diabetes integrated healthcare services in Tanzania. Therefore, this study explored the availability and examined the readiness of healthcare facilities with tuberculosis services to manage diabetes mellitus in Tanzania. Methods We abstracted data from the 2014–2015 Tanzania Service Provision Assessment Survey datasets. The service availability was assessed by calculating the proportion of tuberculosis facilities reported to manage diabetes mellitus. There were four domains; each domain with some indicators for calculating the readiness index. High readiness was considered if the tuberculosis facilities scored at least half (≥50%) of the indicators listed in each of the four domains (staff training and guideline, diagnostics, equipment, and medicines) as is recommended by the World Health Organization-Service Availability and Readiness Assessment manual while low readiness for otherwise. Results Out of 341 healthcare facilities with tuberculosis services included in the current study, 238 (70.0%) reported providing management for diabetes mellitus. The majority of the facilities were dispensaries and clinics 48.1%; publicly owned 72.6%; and located in rural 62.6%. Overall, the readiness of tuberculosis facilities to manage diabetes was low (10.8%). Similarly, the readiness was low based on the domain-specific readiness of trained staff and guidelines. Conclusion Although the majority of the healthcare facilities with tuberculosis services had diabetes mellitus services the overall readiness was low. This finding provides a piece of evidence to inform the policymakers in high burden and low resource countries to strengthen the co-management of tuberculosis and diabetes.
Collapse
Affiliation(s)
- Festo K. Shayo
- Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- * E-mail:
| | - Sigfrid Casmir Shayo
- Department of Diabetes and Endocrinology, Kagoshima University, Kagoshima, Japan
| |
Collapse
|
36
|
Mabula PL, Kazinyingia KI, Chavala EC, Mosha V, Msuya SE, Leyaro BJ. Prevalence and risk factors for diabetes mellitus among tuberculosis patients in Moshi Municipal Council, Kilimanjaro Tanzania. East Afr Health Res J 2021; 5:69-74. [PMID: 34308247 PMCID: PMC8291211 DOI: 10.24248/eahrj.v5i1.653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 05/20/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Diabetes Mellitus (DM) is a worldwide public health problem and its prevalence has been rising rapidly in low and middle income countries (LMICs) including Tanzania. According to WHO report 2015, DM is ranked number six as a leading cause of death worldwide. Strong evidence suggests that DM may be associated with Tuberculosis (TB) and could affect TB treatment outcomes. Tanzania is among the 22 countries that have a high burden of TB and currently facing increased epidemic of DM. The increasing diabetes prevalence may be a threat to TB control and counteract strategies to end TB by 2030 as proposed by WHO. OBJECTIVE To determine proportion of TB patients who are co-infected with DM in Moshi municipal council, Kilimanjaro Tanzania. METHODOLOGY This study was a hospital based cross-sectional study conducted in April to July 2018 at 4 health facilities; Mawenzi Regional Referral hospital, St. Joseph District Designated hospital, Pasua Health center and Majengo Health centre in Moshi municipal. The study included adults aged 18 years and above attending either of the 4 health facilities for TB care. The study included newly diagnosed and those who were on TB treatment. Interviews were conducted followed by blood glucose testing. Data was entered and analysed using SPSS. RESULTS A total of 153 TB patients were enrolled, their mean age was 42.5 (±14.75) years and 46 (30.1%) were females. The prevalence of DM among TB patients in this study was 9.2%. Factors associated with TB-DM comorbidity were: age (OR 4.43, 95% CI: 1.18-16.55), HIV status (OR 3.88, 95% CI: 1.06-14.11), and family history of DM (OR 6.50, 95% CI 0.67-25.56). CONCLUSION One in ten patients with TB had confirmed DM. There is a need for future studies to assess if DM influences TB treatment and outcomes in this setting.
Collapse
Affiliation(s)
- Patrick L. Mabula
- Kilimanjaro Christian Medical University College (KCMUCo), Tanzania
- Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | | | | | - Victor Mosha
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sia E. Msuya
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Tanzania
- Community Health Department, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | - Beatrice John Leyaro
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Tanzania
| |
Collapse
|
37
|
You N, Pan H, Zeng Y, Lu P, Zhu L, Lu W, Liu Q, Martinez L. A risk score for prediction of poor treatment outcomes among tuberculosis patients with diagnosed diabetes mellitus from eastern China. Sci Rep 2021; 11:11219. [PMID: 34045573 PMCID: PMC8160203 DOI: 10.1038/s41598-021-90664-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/13/2021] [Indexed: 11/09/2022] Open
Abstract
Persons living with diabetes (PLWD) with newly diagnosed tuberculosis are at greater risk of poor treatment outcomes. Identifying and prioritizing high-risk subgroups of PLWD and tuberculosis for tuberculosis programs to target has been rarely performed. We investigated risk factors for poor tuberculosis treatment outcomes among PLWD and developed a predictive risk score for tuberculosis control prioritization. Among PLWD diagnosed with tuberculosis, demographic, clinical, and tuberculosis treatment outcome data were collected. Poor treatment outcomes included treatment failure, death, default, and transfer. Multivariable logistic regression modeling was used to analyze risk factors of poor treatment outcomes. Risk scores were derived based on regression coefficients to classify participants at low-, intermediate-, and high-risk of poor treatment outcomes. Among 335 PLWD newly diagnosed with tuberculosis, 109 were cured and 172 completed treatment. Multivariable logistic regression found that risk factors of poor treatment outcomes included bacteriologically-positivity, low body mass index, no physical activity, and pulmonary cavitation. Rates of poor treatment outcomes in low- (0-2), intermediate- (3-4), and high-risk (5-8) groups were 4.2%, 10.5%, and 55.4% (Ptrend < 0.0001), respectively. The risk score accurately discriminated poor and successful treatment outcomes (C-statistic, 0.85, 95% CI 0.78-0.91). We derived a simple predictive risk score that accurately distinguished those at high- and low-risk of treatment failure. This score provides a potentially useful tool for tuberculosis control programs in settings with a double burden of both tuberculosis and diabetes.
Collapse
Affiliation(s)
- Nannan You
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, China
- The Second Affiliated Hospital of Zhejiang, Chinese Medical University, Hangzhou, Zhejiang Province, China
| | - Hongqiu Pan
- Department of Tuberculosis, The Third People's Hospital of Zhenjiang Affiliated To Jiangsu University, Zhenjiang, Jiangsu Province, China
| | - Yi Zeng
- Department of Tuberculosis of Three, Nanjing Public Health Medical Center, Nanjing Second Hospital, Nanjing Hospital Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Peng Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, China
| | - Limei Zhu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, China
| | - Wei Lu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, China
| | - Qiao Liu
- Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, Jiangsu Province, China.
| | - Leonardo Martinez
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| |
Collapse
|
38
|
Tamuhla T, Dave JA, Raubenheimer P, Tiffin N. Diabetes in a TB and HIV-endemic South African population: Analysis of a virtual cohort using routine health data. PLoS One 2021; 16:e0251303. [PMID: 33961671 PMCID: PMC8104376 DOI: 10.1371/journal.pone.0251303] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 04/24/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It is widely accepted that people living with diabetes (PLWD) are at increased risk of infectious disease, yet there is a paucity of epidemiology studies on the relationship between diabetes and infectious disease in SSA. In a region with a high burden of infectious disease, this has serious consequences for PLWD. METHODS AND FINDINGS Using routinely collected longitudinal health data, we describe the epidemiology of diabetes in a large virtual cohort of PLWD who have a high burden of HIV and TB, from the Khayelitsha subdistrict in the Western Cape Province in South Africa. We described the relationship between previous TB, newly diagnosed TB disease and HIV infection on diabetes using HbA1c results as an outcome measure. The study population was predominately female (67%), 13% had a history of active TB disease and 18% were HIV positive. The HIV positive group had diabetes ascertained at a significantly younger age (46 years c.f. 53 years respectively, p<0.001) and in general had increased HbA1c values over time after their HIV diagnosis, when compared to the HIV-negative group. There was no evidence of TB disease influencing the trajectory of glycaemic control in the long term, but diabetes patients who developed active TB had higher mortality than those without TB (12.4% vs 6.7% p-value < 0.001). HIV and diabetes are both chronic diseases whose long-term management includes drug therapy, however, only 52.8% of the study population with an HIV-diabetes comorbidity had a record of diabetes treatment. In addition, the data suggest overall poor glycaemic control in the study population with only 24.5% of the participants having an HbA1c <7% at baseline despite 85% of the study population being on diabetes treatment. CONCLUSION The epidemiologic findings in this exploratory study highlight the need for further research into diabetes outcomes in a high TB and HIV burden setting and demonstrate that routine health data are a valuable resource for understanding disease epidemiology in the general population.
Collapse
Affiliation(s)
- Tsaone Tamuhla
- Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Joel A. Dave
- Division of Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town (UCT), Cape Town, South Africa
| | - Peter Raubenheimer
- Division of Endocrinology, Department of Medicine, Faculty of Health Sciences, University of Cape Town (UCT), Cape Town, South Africa
| | - Nicki Tiffin
- Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
39
|
Antonio-Arques V, Franch-Nadal J, Caylà JA. Diabetes and tuberculosis: a syndemic complicated by COVID-19. Med Clin (Barc) 2021; 157:288-293. [PMID: 34049681 PMCID: PMC8101986 DOI: 10.1016/j.medcli.2021.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 01/16/2023]
Abstract
Tuberculosis (TB) is the leading cause of infectious mortality in the world, affecting mainly developing countries (DC), while diabetes (DM) is one of the most prevalent chronic diseases. This review analyzes the fact that diabetes is currently an important risk factor for developing TB, also presenting more complicated TB, more relapses and higher mortality. The DCs and the fourth world of the large cities are those with the highest incidence of TB and an increase in DM, which will make it difficult to control tuberculosis disease. At the same time, the COVID-19 pandemic is complicating the management of both diseases due to the difficulty of access to control and treatment and the worsening of socioeconomic inequalities. It is necessary to establish a bidirectional screening for TB and DM and promote recommendations for the joint management of both diseases.
Collapse
Affiliation(s)
- Violeta Antonio-Arques
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España; Equip d'Atenció Primària (EAP) Bordeta Magòria, Institut Català de la Salut, Barcelona, España
| | - Josep Franch-Nadal
- Institut Universitari per a la Recerca en Atenció Primària (IDIAP) Jordi Gol, Barcelona, España; Equip d'Atenció Primària (EAP) Raval Sud - Drassanes, Institut Català de la Salut, Barcelona, España.
| | - Joan A Caylà
- Fundación de la Unidad de Investigación en Tuberculosis de Barcelona, Barcelona, España
| |
Collapse
|
40
|
Kubjane M, Berkowitz N, Goliath R, Levitt NS, Wilkinson RJ, Oni T. Tuberculosis, Human Immunodeficiency Virus, and the Association With Transient Hyperglycemia in Periurban South Africa. Clin Infect Dis 2021; 71:1080-1088. [PMID: 31557282 PMCID: PMC7428387 DOI: 10.1093/cid/ciz928] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 09/16/2019] [Indexed: 12/27/2022] Open
Abstract
Background Diabetes mellitus (DM) increases tuberculosis (TB) risk. We assessed the prevalence of hyperglycemia (DM and impaired glucose regulation [IGR]) in persons with TB and the association between hyperglycemia and TB at enrollment and 3 months after TB treatment in the context of human immunodeficiency virus (HIV) infection. Methods Adults presenting at a Cape Town TB clinic were enrolled. TB cases were defined by South African guidelines, while non-TB participants were those who presented with respiratory symptoms, negative TB tests, and resolution of symptoms 3 months later without TB treatment. HIV status was ascertained through medical records or HIV testing. All participants were screened for DM using glycated hemoglobin and fasting plasma glucose at TB treatment and after 3 months. The association between TB and DM was assessed. Results Overall DM prevalence was 11.9% (95% confidence interval [CI], 9.1%–15.4%) at enrollment and 9.3% (95% CI, 6.4%–13%) at follow-up; IGR prevalence was 46.9% (95% CI, 42.2%–51.8%) and 21.5% (95% CI, 16.9%–26.3%) at enrollment and follow-up. TB/DM association was significant at enrollment (odds ratio [OR], 2.41 [95% CI, 1.3–4.3]) and follow-up (OR, 3.3 [95% CI, 1.5–7.3]), whereas TB/IGR association was only positive at enrollment (OR, 2.3 [95% CI, 1.6–3.3]). The TB/DM association was significant at enrollment in both new and preexisting DM, but only persisted at follow-up in preexisting DM in patients with HIV-1 infection. Conclusions Our study demonstrated high prevalence of transient hyperglycemia and a significant TB/DM and TB/IGR association at enrollment in newly diagnosed DM, but persistent hyperglycemia and TB/DM association in patients with HIV-1 infection and preexisting DM, despite TB therapy.
Collapse
Affiliation(s)
- Mmamapudi Kubjane
- Division of Public Health Medicine, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Natacha Berkowitz
- Division of Public Health Medicine, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Rene Goliath
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Observatory, South Africa
| | - Naomi S Levitt
- Division of Diabetes and Endocrinology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa and Chronic Disease Initiative for Africa
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Observatory, South Africa.,The Francis Crick Institute, London, United Kingdom.,Department of Infectious Diseases, Imperial College London, United Kingdom
| | - Tolu Oni
- Division of Public Health Medicine, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.,Wellcome Centre for Infectious Disease Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Observatory, South Africa.,Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| |
Collapse
|
41
|
van Crevel R, Critchley JA. The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice. Trop Med Infect Dis 2021; 6:tropicalmed6010008. [PMID: 33435609 PMCID: PMC7838867 DOI: 10.3390/tropicalmed6010008] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 12/17/2022] Open
Abstract
Diabetes Mellitus increases the risk of developing Tuberculosis (TB) disease by about three times; it also doubles the risk of death during TB treatment and other poor TB treatment outcomes. Diabetes may increase the risk of latent infection with Mycobacterium tuberculosis (LTBI), but the magnitude of this effect is less clear. Whilst this syndemic has received considerable attention, most of the published research has focussed on screening for undiagnosed diabetes in TB patients or observational follow-up of TB treatment outcomes by diabetes status. There are thus substantial research and policy gaps, particularly with regard to prevention of TB disease in people with diabetes and management of patients with TB-diabetes, both during TB treatment and after successful completion of TB treatment, when they likely remain at high risk of TB recurrence, mortality from TB and cardiovascular disease. Potential strategies to prevent development of TB disease might include targeted vaccination programmes, screening for LTBI and preventive therapy among diabetes patients or, perhaps ideally, improved diabetes management and prevention. The cost-effectiveness of each of these, and in particular how each strategy might compare with targeted TB prevention among other population groups at higher risk of developing TB disease, is also unknown. Despite research gaps, clinicians urgently need practical management advice and more research evidence on the choice and dose of different anti-diabetes medication and effective medical therapies to reduce cardiovascular risks (statins, anti-hypertensives and aspirin). Substantial health system strengthening and integration may be needed to prevent these at risk patients being lost to care at the end of TB treatment.
Collapse
Affiliation(s)
- Reinout van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6500HB Nijmegen, The Netherlands
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford OX3 7LG, UK
- Correspondence:
| | - Julia A. Critchley
- Population Health Research Institute, St George’s, University of London, London SW17 ORE, UK;
| |
Collapse
|
42
|
Ugarte-Gil C, Alisjahbana B, Ronacher K, Riza AL, Koesoemadinata RC, Malherbe ST, Cioboata R, Llontop JC, Kleynhans L, Lopez S, Santoso P, Marius C, Villaizan K, Ruslami R, Walzl G, Panduru NM, Dockrell HM, Hill PC, Mc Allister S, Pearson F, Moore DAJ, Critchley JA, van Crevel R. Diabetes Mellitus Among Pulmonary Tuberculosis Patients From 4 Tuberculosis-endemic Countries: The TANDEM Study. Clin Infect Dis 2021; 70:780-788. [PMID: 30958536 DOI: 10.1093/cid/ciz284] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 04/03/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) increases active tuberculosis (TB) risk and worsens TB outcomes, jeopardizing TB control especially in TB-endemic countries with rising DM prevalence rates. We assessed DM status and clinical correlates in TB patients across settings in Indonesia, Peru, Romania, and South Africa. METHODS Age-adjusted DM prevalence was estimated using laboratory glycated hemoglobin (HbA1c) or fasting plasma glucose in TB patients. Detailed and standardized sociodemographic, anthropometric, and clinical measurements were made. Characteristics of TB patients with or without DM were compared using multilevel mixed-effect regression models with robust standard errors. RESULTS Of 2185 TB patients (median age 36.6 years, 61.2% male, 3.8% human immunodeficiency virus-infected), 12.5% (267/2128) had DM, one third of whom were newly diagnosed. Age-standardized DM prevalence ranged from 10.9% (South Africa) to 19.7% (Indonesia). Median HbA1c in TB-DM patients ranged from 7.4% (Romania) to 11.3% (Indonesia). Compared to those without DM, TB-DM patients were older and had a higher body mass index (BMI) (P value < .05). Compared to those with newly diagnosed DM, TB patients with diagnosed DM had higher BMI and HbA1c, less severe TB, and more frequent comorbidities, DM complications, and hypertension (P value < .05). CONCLUSIONS We show that DM prevalence and clinical characteristics of TB-DM vary across settings. Diabetes is primarily known but untreated, hyperglycemia is often severe, and many patients with TB-DM have significant cardiovascular disease risk and severe TB. This underlines the need to improve strategies for better clinical management of combined TB and DM.
Collapse
Affiliation(s)
- Cesar Ugarte-Gil
- School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,TB Centre, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Bachti Alisjahbana
- Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia.,Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Katharina Ronacher
- South African Department of Science & Technology and the National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.,Translational Research Institute, Mater Research Institute-University of Queensland, Brisbane, Australia
| | - Anca Lelia Riza
- Department of Internal Medicine and Radboud Center of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania.,Regional Centre for Human Genetics-Dolj, Emergency Clinical County Hospital, Craiova, Romania
| | - Raspati C Koesoemadinata
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Stephanus T Malherbe
- South African Department of Science & Technology and the National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - Ramona Cioboata
- Hospital for Infectious Diseases and Pneumology "Victor Babeș," Craiova, Romania
| | | | - Leanie Kleynhans
- South African Department of Science & Technology and the National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - Sonia Lopez
- Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Prayudi Santoso
- Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia.,Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Ciontea Marius
- Pneumology Hospital Tudor Vladimirescu, Dobrita, jud. Gorj, Bucharest, Romania
| | - Katerine Villaizan
- Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Rovina Ruslami
- Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Gerhard Walzl
- South African Department of Science & Technology and the National Research Foundation Centre of Excellence for Biomedical Tuberculosis Research, South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town
| | - Nicolae Mircea Panduru
- 2nd Clinical Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Hazel M Dockrell
- Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Philip C Hill
- Centre for International Health, University of Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Susan Mc Allister
- Centre for International Health, University of Otago Medical School, University of Otago, Dunedin, New Zealand
| | - Fiona Pearson
- Population Health Research Institute, St Georges, University of London, United Kingdom
| | - David A J Moore
- TB Centre, London School of Hygiene and Tropical Medicine, United Kingdom.,Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Julia A Critchley
- Population Health Research Institute, St Georges, University of London, United Kingdom
| | - Reinout van Crevel
- Department of Internal Medicine and Radboud Center of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
43
|
Araia ZZ, Mesfin AB, Mebrahtu AH, Tewelde AG, Osman R, Tuumzghi HA. Diabetes Mellitus and Its Associated Factors in Tuberculosis Patients in Maekel Region, Eritrea: Analytical Cross-Sectional Study. Diabetes Metab Syndr Obes 2021; 14:515-523. [PMID: 33568928 PMCID: PMC7869713 DOI: 10.2147/dmso.s293557] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 01/21/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Both diabetes mellitus (DM) and tuberculosis (TB) are among the leading causes of morbidity and mortality in Eritrea. TB-DM comorbidity is known to complicate TB care, control and prevention. However, systematically studied epidemiological data on TB-DM comorbidity and its associated risk factors are lacking in this country. OBJECTIVE This study aimed to assess the prevalence of DM and its associated factors among TB patients in the Maekel region, Eritrea. METHODS Analytical cross-sectional study was conducted in eleven TB diagnostic and treatment sites. Pretested data extraction tool was used to collect data from medical records. Prevalence data were analysed using frequencies, proportions and median. To determine DM risk factors, univariable and multivariable logistic regression analysis was done with 95% CI and p value < 0.05 considered significant. RESULTS Out of total eligible (1134) TB cases, DM prevalence was 9.88%. Age and BMI were identified as independent risk factors for DM among TB patients. Higher odds of DM were found among TB patients aged 45-54 (aOR: 4.85[1.39-16.94], p= 0.013) and those ≥55 (aOR: 6.99[2.12-23.04], p= 0.001). TB cases with normal BMI were two times more likely to have DM (aOR: 2.00[1.23-3.26], p= 0.005) compared to those underweight. CONCLUSION The prevalence of DM among TB cases observed in this study is high, a clarion call to scale up current efforts to integrate TB-DM services within routine care. Furthermore, age and BMI were identified as independent risk factors for DM in TB cases, pointing to the need to pay attention to age and BMI status when managing this co-morbidity.
Collapse
Affiliation(s)
- Zenawi Zeramariam Araia
- National TB and Leprosy Control Program, Communicable Disease Control Division, Ministry of Health, Asmara, Eritrea
- Correspondence: Zenawi Zeramariam Araia National TB and Leprosy Control Program, Communicable Diseases Control Division, Ministry of Health, Asmara, EritreaTel +291-1-122129 Email
| | | | - Amanuel Hadgu Mebrahtu
- National TB and Leprosy Control Program, Communicable Disease Control Division, Ministry of Health, Asmara, Eritrea
| | | | - Randa Osman
- Orrota College of Medicine and Health Sciences, Asmara, Eritrea
| | | |
Collapse
|
44
|
Menon S, Rossi R, Dusabimana A, Zdraveska N, Bhattacharyya S, Francis J. The epidemiology of tuberculosis-associated hyperglycemia in individuals newly screened for type 2 diabetes mellitus: systematic review and meta-analysis. BMC Infect Dis 2020; 20:937. [PMID: 33297969 PMCID: PMC7724718 DOI: 10.1186/s12879-020-05512-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 10/13/2020] [Indexed: 01/29/2023] Open
Abstract
Background There is scarce evidence that tuberculosis (TB) can cause diabetes in those not previously known to be diabetic. Whilst the World Health Organization (WHO) recommends screening for Diabetes Mellitus (DM) at the onset of TB treatment, nevertheless, it remains to be elucidated which patients with TB-associated hyperglycemia are at higher risk for developing DM and stand to benefit from a more regular follow-up. This review aims to firstly quantify the reduction of newly detected hyperglycemia burden in TB patients who are on treatment over time; secondly, determine the burden of TB-associated hyperglycemia after follow-up, and thirdly, synthesize literature on risk factors for unresolved TB-associated hyperglycemia in previously undiagnosed individuals. Methods We searched PUBMED, EMBASE, SCOPUS, and Global Health for articles on TB-associated hyperglycemia up to September 30th, 2019. Search terms included Tuberculosis and hyperglycemia/DM, and insulin resistance. We appraised studies, extracted data, and conducted a meta-analysis to assess the change of the burden of hyperglycemia in prospective studies. The review is registered in the PROSPERO database (CRD42019118173). Results Eleven studies were included in the meta-analysis yielding a total of 677 (27,3%) of patients with newly detected hyperglycemia at baseline. The mean quality score of eligible studies using the Newcastle-Ottawa Quality Assessment Scale was 7.1 out of 9 (range 6-9). The pooled unresolved new cases of hyperglycemia at the end of follow up was 50% (95% CI: 36–64%) and the total pooled burden of hyperglycemia at 3–6 months of follow up was 11% (95% CI: 7–16%), with both estimates displaying a high heterogeneity, which remained significant after performing a sub-analysis by DM diagnostic method and 3 months of follow up. As only 2 studies explored risk factors for unresolved hyperglycemia, no meta-analysis was performed on risk factors. Conclusion Our meta-analysis showed that although in half of the patients with newly observed hyperglycemia at baseline, it remained unresolved at a follow-up of 3 to 6 months, the total burden of hyperglycemia is slightly above 10%, 3 months after initiating TB treatment. Studies are warranted to assess whether risk factors including HIV positivity, smoking, and extensive pulmonary TB disease put patients at higher risk for DM. Supplementary information Supplementary information accompanies this paper at 10.1186/s12879-020-05512-7.
Collapse
Affiliation(s)
- Sonia Menon
- Global Health Institute, University of Antwerp, Antwerp, Belgium. .,Department of Public Health, Institute of Tropical Medicine, Sint Rochusstraat 43, 2000, Antwerp, Belgium.
| | - Rodolfo Rossi
- International Committee of the Red Cross, Geneva, Switzerland
| | | | - Natasha Zdraveska
- Specialized hospital for Geriatric and Palliative medicine, Skopje, Republic of North Macedonia
| | - Samit Bhattacharyya
- Department of Mathematics, School of Natural Sciences, Shiv Nadar University, Uttar Pradesh, India
| | - Joel Francis
- Department of Family Medicine and Primary Care, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
45
|
Metformin enhances protection in guinea pigs chronically infected with Mycobacterium tuberculosis. Sci Rep 2020; 10:16257. [PMID: 33004826 PMCID: PMC7530990 DOI: 10.1038/s41598-020-73212-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023] Open
Abstract
Tuberculosis (TB) is a chronic inflammatory disease that is often associated with alterations in systemic and cellular metabolism that resolves following successful antimicrobial drug treatment. We hypothesized that altered systemic glucose metabolism as a consequence of Mycobacterium tuberculosis (Mtb) infection, contributes to TB pathogenesis, and when normalized with anti-glycemic drugs would improve clinical outcomes. To test this hypothesis, guinea pigs were treated daily with the anti-diabetic drug metformin starting 4 weeks prior or concurrent with aerosol exposure to the H37Rv strain of Mtb. In the chronic stages of infection, Mtb infected metformin-treated animals had restored systemic insulin sensitivity but remained glucose intolerant as determined by oral glucose tolerance testing. Despite persistent glucose intolerance, metformin-treated guinea pigs had a 2.8-fold reduction in lung lesion burden and a 0.7 log decrease in CFUs. An alternative hypothesis that metformin treatment improved clinical disease by having a direct effect on immune cell energy metabolism was tested using extracellular flux analysis and flow cytometry. The proinflammatory immune response to Mtb infection in untreated guinea pigs was associated with a marked increase in energy metabolism (glycolysis and mitochondrial respiration) of peripheral blood mononuclear cells (PBMCs), which was normalized in metformin-treated guinea pigs. Moreover, both CD4+ and CD8+ T lymphocytes from Mtb infected, metformin treated animals maintained a more normal mitochondrial membrane potential while those isolated from untreated animals had persistent mitochondrial hyperpolarization. These data suggest that metformin promotes natural host resistance to Mtb infection by maintaining immune cell metabolic homeostasis and function during the chronic stages of active TB disease.
Collapse
|
46
|
Hodel NC, Hamad A, Reither K, Mwangoka G, Kasella I, Praehauser C, Abdulla S, Hatz CFR, Mayr M. Assessment of diabetes and prediabetes prevalence and predictors by HbA1c in a population from sub-Saharan Africa with a high proportion of anemia: a prospective cross-sectional study. BMJ Open Diabetes Res Care 2020; 8:8/1/e000939. [PMID: 32439737 PMCID: PMC7247378 DOI: 10.1136/bmjdrc-2019-000939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/18/2020] [Accepted: 03/24/2020] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Epidemiological data about diabetes mellitus (DM) for sub-Saharan Africa (SSA) are scarce and the utility of glycated hemoglobin (HbA1c) to diagnose DM is uncertain in African populations with a high proportion of anemia. RESEARCH DESIGN AND METHODS In a cross-sectional study, age-adjusted prevalence rates and predictors for DM and pre-DM were prospectively assessed by HbA1c in a semirural walk-in population of Tanzania (n=992). Predictors for DM were calculated by logistic regression. Correlations between HbA1c, hemoglobin, and blood glucose levels were done by Pearson's correlation. RESULTS Overall, DM and pre-DM prevalence rates were 6.8% (95% CI 5.3 to 8.5) and 25% (95% CI 22.8 to 28.3), respectively. There was an increase in DM prevalence in patients 50-59 (14.9%; 95% CI 9.1 to 22.5), ≥60 years old (18.5%; 95% CI 12.2 to 26.2) and in patients with overweight (9.3%; 95% CI 5.9 to 13.7), obesity (10.9%; 95% CI 6.9 to 16) compared with patients 18-29 years old (2.2%; 95% CI 0.9 to 4.4) (p<0.001) and to normal-weight patients (3.6%; 95% CI 2.1 to 5.6) (p<0.01), respectively. Age (OR 1.08, 95% CI 1.05 to 1.12; p<0.001), body mass index (BMI) (OR 1.10, 95% CI 1.04 to 1.16; p<0.001), and acute infection (OR 3.46, 95% CI 1.02 to 10.8; p=0.038) were predictors for DM. Comparing patients with a BMI of 20 kg/m2 and a BMI of 35 kg/m2, the relative risk for DM increases in average by 2.12-fold (range 1.91-2.24) across the age groups. Comparing patients 20 years old with patients 70 years old, the relative risk for DM increases in average 9.7-fold (range 8.9-10.4) across the BMI groups. Overall, 333 patients (36%) suffered from anemia. Pearson's correlation coefficients (r) between HbA1c and hemoglobin was -0.009 (p=0.779), and between HbA1c and fasting blood glucose and random blood glucose, it was 0.775 and 0.622, respectively (p<0.001). CONCLUSION We observed a high prevalence of DM and pre-DM, mainly triggered by increasing age and BMI, and provide evidence that HbA1c is suitable to assess DM also in populations of SSA with high proportions of anemia. TRIAL REGISTRATION NUMBER NCT03458338.
Collapse
Affiliation(s)
- Nikolai Carl Hodel
- Medical Outpatient Department, Universitätsspital Basel, Basel, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Ali Hamad
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Klaus Reither
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Ifakara Health Institute, Dar es Salaam, Tanzania
| | | | - Irene Kasella
- Medical Outpatient Department, Bagamoyo District Hospital, Bagamoyo, Tanzania
| | - Claudia Praehauser
- Medical Outpatient Department, Universitätsspital Basel, Basel, Switzerland
| | | | - Christoph F R Hatz
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Cantonal Hospital Sankt Gallen, St. Gallen, Switzerland
| | - Michael Mayr
- Medical Outpatient Department, Universitätsspital Basel, Basel, Switzerland
| |
Collapse
|
47
|
Habib SS, Rafiq S, Jamal WZ, Ayub SM, Ferrand RA, Khan A, Zaidi SMA. Engagement of private healthcare providers for case finding of tuberculosis and diabetes mellitus in Pakistan. BMC Health Serv Res 2020; 20:328. [PMID: 32306961 PMCID: PMC7168982 DOI: 10.1186/s12913-020-05217-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/13/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The rising co-epidemic of tuberculosis (TB) and diabetes mellitus (DM) is a challenge for constrained health systems in low and middle-income countries. Diabetes is a known risk factor for tuberculosis and associated with poor tuberculosis treatment outcomes, while tuberculosis is associated with worsening glycemic control. We investigated the performance of bi-directional TB and DM case finding approaches through a private-sector engagement model in Karachi, Pakistan. METHODS Between July 2016 and July 2018, private health care providers were engaged to generate referrals for bi-directional TB and DM screening at private diagnostic and treatment centers in Karachi, Pakistan. Individuals diagnosed with TB underwent glycated hemoglobin (HbA1c) testing at the time of anti-tuberculous treatment initiation and at three -month follow up stage. All individuals with a history of diabetes or random blood sugar of greater than 200 mg/dl were screened for TB using a chest X-ray and Xpert MTB/RIF. RESULTS A total of 6312 persons with tuberculosis were tested on HbA1c at treatment initiation, of whom 1516 (24%) were newly diagnosed with DM. About one third of those with HbA1c in the diabetic range (≥ 6.5%) at baseline were found to have a normal HbA1c (< 5.7%) result at 3-month follow-up. A total of 3824 individuals with DM, of whom 2396 (63%) were known cases and 1428 (37%) were newly identified with random blood sugar > 200 mg/dl, underwent chest x-ray and Xpert MTB/RIF testing, with 321 (13.4%) known and 54 (3.8%) new diabetics respectively identified with tuberculosis. CONCLUSION This study demonstrates a high yield of TB and DM through bidirectional screening and the feasibility of engagement of private sector in finding missing cases of tuberculosis and diabetes. Given the high prevalence of undiagnosed DM in individuals with TB tuberculosis patients, there is a need to scale-up DM screening within TB programmes. Increased awareness of the high risk of TB among individuals with DM is needed among private health providers and screening for TB among diabetics should be strongly considered.
Collapse
Affiliation(s)
- Shifa Salman Habib
- Community Health Solutions, 9th Floor, Al-Tijarah Building, Main Shahrah-e-Faisal, Karachi, Pakistan
| | - Sana Rafiq
- Community Health Solutions, 9th Floor, Al-Tijarah Building, Main Shahrah-e-Faisal, Karachi, Pakistan
| | - Wafa Zehra Jamal
- Community Health Solutions, 9th Floor, Al-Tijarah Building, Main Shahrah-e-Faisal, Karachi, Pakistan
| | - Shaikh Muhammad Ayub
- Community Health Solutions, 9th Floor, Al-Tijarah Building, Main Shahrah-e-Faisal, Karachi, Pakistan
| | - Rashida Abbas Ferrand
- London School of Hygiene and Tropical Medicine, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Aamir Khan
- Interactive Research & Development, 4th Floor, Woodcraft Building, Plot No. 3 & 3-A, Sector 47, Korangi Creek Road, Karachi, Pakistan
| | - Syed Mohammad Asad Zaidi
- Community Health Solutions, 9th Floor, Al-Tijarah Building, Main Shahrah-e-Faisal, Karachi, Pakistan
| |
Collapse
|
48
|
Munseri PJ, Kimambo H, Pallangyo K. Diabetes mellitus among patients attending TB clinics in Dar es Salaam: a descriptive cross-sectional study. BMC Infect Dis 2019; 19:915. [PMID: 31664936 PMCID: PMC6820980 DOI: 10.1186/s12879-019-4539-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 10/09/2019] [Indexed: 01/15/2023] Open
Abstract
Background A bi-directional interaction between diabetes mellitus and tuberculosis is well established and has been likened to that between HIV and TB. Whereas HIV screening is standard of care test in sub Saharan Africa TB programs, the same is not true for diabetes mellitus (DM). Sub Saharan Africa, a region with high TB infection rates, is going through an epidemiological transition with rapidly rising prevalence of diabetes. We aimed at characterizing TB patients with DM in order to identify factors associated with TB-DM dual disease among patients attending TB clinics in Dar es Salaam. Methods A cross-sectional study was conducted between September 2016 and January 2017 among patients attending TB clinics in Dar es Salaam. We collected socio-demographic characteristics, anthropometric measurements and screened for diabetes by measuring fasting blood glucose that was followed by a 2 h postprandial glucose for participants with impaired fasting blood glucose. We examined for socio-demographic and clinical factors associated with diabetes using logistic regression analysis. Results Of the 660 enrolled participants with TB, 25 (3.8%) were on treatment for diabetes while 39 (6.1%) and 147 (23%) of the remaining 635 participants were ultimately diagnosed with DM and impaired fasting blood glucose respectively. The overall prevalence of DM was 9.7% (64/660). Independent risk factors for diabetes included: age > 44 years {OR 4.52, 95% CI: [1.28–15.89]}; family history of diabetes {OR 3.42, 95% [CI 1.88–6.21]}. HIV sero-positive TB patients were less likely to have DM compared to those who were HIV sero-negative {OR 0.35, 95% CI [0.17–0.73]}. Conclusions Screening for diabetes should be advocated for TB patients aged above 44 years and/or with a family history of diabetes. HIV sero-negative TB patients were more likely to have DM compared to those who were HIV sero-positive. Further studies are needed to confirm this observation and the underlying factors.
Collapse
Affiliation(s)
- Patricia J Munseri
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences Dar es Salaam, Box 65315, Dar es Salaam, Tanzania.
| | - Henrika Kimambo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences Dar es Salaam, Box 65315, Dar es Salaam, Tanzania
| | - Kisali Pallangyo
- Department of Internal Medicine, Muhimbili University of Health and Allied Sciences Dar es Salaam, Box 65315, Dar es Salaam, Tanzania
| |
Collapse
|
49
|
Eze IC, Essé C, Bassa FK, Koné S, Acka F, Schindler C, Imboden M, Laubhouet-Koffi V, Kouassi D, N'Goran EK, Utzinger J, Bonfoh B, Probst-Hensch N. Asymptomatic Plasmodium infection and glycemic control in adults: Results from a population-based survey in south-central Côte d'Ivoire. Diabetes Res Clin Pract 2019; 156:107845. [PMID: 31520711 DOI: 10.1016/j.diabres.2019.107845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/14/2019] [Accepted: 09/06/2019] [Indexed: 02/03/2023]
Abstract
AIMS We investigated the cross-sectional associations of Plasmodium infection (PI) with fasting glucose (FG) and glycated hemoglobin (HbA1c) in malaria-endemic south-central Côte d'Ivoire. METHODS We studied 979 participants (non-pregnant; no treated diabetes; 51% males; 18-87 years) of the Côte d'Ivoire Dual Burden of Disease study. Fasting venous blood was obtained for PI, FG, and HbA1c assessment. We defined PI as a positive malaria rapid diagnostic test (RDT) or microscopic identification of Plasmodium species. We applied multivariable linear regressions to assess beta coefficients (β) and 95% confidence intervals (CIs) of PI positivity for FG and HbA1c independent of diabetes risk factors. RESULTS Prevalence of PI was 10.1% (5.5% microscopy; 9.7% RDT) without clinical fever. Prevalence of FG-based prediabetes (45.8%) and diabetes (3.6%) were considerably higher than HbA1c-based values (2.7% and 0.7%, respectively). PI was independently associated with FG among participants with higher body temperature (β 0.34, 95% CI 0.06-0.63, pheterogeneity = 0.028), or family history of diabetes (β 0.88, 95% CI 0.28-1.47, pheterogeneity = 0.009). Similar patterns observed with HbA1c were obliterated on accounting for FG. We also observed consistent associations with parasite density. CONCLUSIONS FG-based diabetes diagnosis in the presence of asymptomatic PI may misclassify or overestimate diabetes burden in malaria-endemic settings. Longitudinal studies are needed to confirm these findings and determine the risk for diabetes.
Collapse
Affiliation(s)
- Ikenna C Eze
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland.
| | - Clémence Essé
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire; Institut d'Ethnologie, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Fidèle K Bassa
- Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Siaka Koné
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Félix Acka
- Institut National de Santé Publique, Abidjan, Côte d'Ivoire
| | - Christian Schindler
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Véronique Laubhouet-Koffi
- Ligue Ivoirienne contre l'Hypertension Artérielle et les Maladies Cardiovasculaires, Abidjan, Côte d'Ivoire
| | - Dinard Kouassi
- Institut National de Santé Publique, Abidjan, Côte d'Ivoire
| | - Eliézer K N'Goran
- Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire; Unité de Formation et de Recherche Biosciences, Université Félix Houphouët-Boigny, Abidjan, Côte d'Ivoire
| | - Jürg Utzinger
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Bassirou Bonfoh
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland; Centre Suisse de Recherches Scientifiques en Côte d'Ivoire, Abidjan, Côte d'Ivoire
| | - Nicole Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| |
Collapse
|
50
|
Kumar NP, Moideen K, Nancy A, Viswanathan V, Shruthi BS, Sivakumar S, Natarajan M, Kornfeld H, Babu S. Heterogeneity in the cytokine profile of tuberculosis - diabetes co-morbidity. Cytokine 2019; 125:154824. [PMID: 31472402 DOI: 10.1016/j.cyto.2019.154824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 01/08/2023]
Abstract
Tuberculosis - diabetes (TB-DM) co-morbidity is characterized by heterogeneity in clinical and biochemical parameters between newly diagnosed diabetic individuals with TB (TB-NDM) and known diabetic individuals at incident TB (TB-KDM). However, the immunological profile underlying this heterogeneity is not explored. To identify the cytokine profiles in TB-NDM and TB-KDM individuals, we examined the plasma cytokine levels as well as TB-antigen stimulated levels of pro-inflammatory cytokines. TB-KDM individuals exhibit significantly higher levels of IFNγ, IL-2, TNFα, IL-17A, IL-1α, IL-1β and IL-6 in comparison to TB-NDM, TB alone and DM alone individuals. TB-NDM individuals are characterized by significantly lower levels of blood glucose and glycated hemoglobin in comparison to TB-KDM with both groups exhibiting a significant lowering of glycated hemoglobin levels at 6 months of anti-tuberculosis therapy (ATT). TB-NDM individuals are characterized by significantly diminished - unstimulated levels of IFNγ, IL-2, TNFα, IL-17A, IL-1α, IL-1β and IL-12 at pre-treatment, of IFNγ, IL-2 and IL-1α at 2 months of ATT and IL-2 at post-treatment in comparison to TB-KDM. TB-NDM individuals are also characterized by significantly diminished TB-antigen stimulated levels of IFNγ, IL-2, TNFα, IL-17A, IL-17F, IL-1α, IL-1β and/or IL-6 at pre-treatment and at 2 months of ATT and IFNγ, IL-2, IL-1α and IL-1β at post-treatment. In addition, TB-NDM individuals are characterized by significantly diminished mitogen - stimulated levels of IL-17F and IL-6 at pre-treatment and IL-6 alone at 6 months of ATT. Therefore, our data reveal considerable heterogeneity in the immunological underpinnings of TB-DM co-morbidity. Our data also suggest that TB-NDM exhibits a characteristic profile, which is both biochemically and immunologically distinct from TB-KDM.
Collapse
Affiliation(s)
- Nathella P Kumar
- National Institutes of Health-NIRT- International Center for Excellence in Research, Chennai, India
| | - Kadar Moideen
- National Institutes of Health-NIRT- International Center for Excellence in Research, Chennai, India
| | - Arul Nancy
- National Institutes of Health-NIRT- International Center for Excellence in Research, Chennai, India; Prof. M. Viswanathan Diabetes Research Center, Chennai, India
| | | | | | | | - Mohan Natarajan
- National Institute for Research in Tuberculosis, Chennai, India
| | - Hardy Kornfeld
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Subash Babu
- National Institutes of Health-NIRT- International Center for Excellence in Research, Chennai, India; University of Massachusetts Medical School, Worcester, MA, USA; LPD, NIAID, NIH, MD, USA.
| |
Collapse
|