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

Estimation of the Proportion and Determinants of Diabetes Mellitus Among Notified Tuberculosis Patients in Jaipur, Rajasthan, India

BACKGROUND

Tuberculosis (TB) and diabetes mellitus (DM) comorbidity is a significant public health problem globally and in India. The present study estimated the proportion and determinants of DM among notified TB patients within the Indian National Tuberculosis Elimination Program (NTEP).

METHODS

The present study is the secondary data analysis of the NTEP data obtained from the District Tuberculosis Office, Jaipur, Rajasthan, India. The total number of TB patients included in the study was 4679. Sociodemographic and clinical data were compared between TB-DM and TB-only patients. Bivariate chi-squared analysis and multivariate logistic regression analysis were employed to understand the determinants of TB-DM comorbidity.

RESULTS

The proportion of DM among the notified TB patients was found to be 0.98% (46). TB-DM patients were significantly older (a mean age of 51.6±12.4 years vs. 34.2±17.3 years; p<0.001) and had higher body weight (51.2±11.4 kg vs. 46.2±12.4 kg; p<0.05) than TB-only patients. Bivariate analysis revealed that males and individuals over 35 years of age had higher odds of TB-DM, with odds ratios of 1.906 (95% CI: 1.015-3.582) and 29.871 (95% CI: 7.233-123.363), respectively. Multivariate binary logistic regression analysis determined that age >=35 years was a significant determinant of TB-DM comorbidity (adjusted odds ratio (AOR): 28.641; 95% CI: 6.818-120.313; p<0.001). There was no significant association of treatment success rate and death rate with TB-DM comorbidity. The comparison of diagnostic and enrollment facilities in diagnosing and enrolling TB-DM revealed that the diagnostic and enrollment of TB-DM patients were higher in private healthcare facilities than in public healthcare facilities.

CONCLUSION

The study results determined that age >35 years is the significant determinant of TB-DM comorbidity. The analysis of diagnostic and enrollment facilities showed that TB-DM patients were more likely to be diagnosed and enrolled in private hospitals than government healthcare facilities. The study findings suggest that there is a need for integrated management approaches that address TB and DM concurrently.

Diabetes mellitus and its determinants among tuberculosis patients in South Gondar Zone health facilities, Northwest Ethiopia

Both tuberculosis (TB) and diabetes mellitus (DM) are major global public health concerns, and their prevalence has been rising rapidly in developing countries like Ethiopia. A challenge to TB control could arise from the rising incidence of diabetes and undermine efforts to eradicate the disease. In Ethiopia, particularly in the research region, there is a lack of data regarding TB-DM comorbidity and associated risk factors. To assess the prevalence and determinants of DM in patients with tuberculosis at South Gondar Zone Hospitals in Ethiopia. A facility-based cross-sectional study was conducted in South Gondar Zone health facilities from December, 2023 to May 2024. A total of 1174 participants were selected using a systematic sampling technique. The data were collected using an interviewer-administered structural questionnaire. Previously and newly diagnosed TB at any stage of anti-TB treatment were subjected to a fasting blood sugar measurement. The collected data was entered into EPI Data 3.1 and exported to SPSS version 24 for analysis. To determine the risk factors, logistic regression was employed. An odds ratio with a 95% CI and a P-value < 0.05 were used to declare statistical significance. The prevalence of diabetes mellitus and prediabetes was found to be 9.8% (95% CI: 7.1-1.35) and 13.5% (95% CI: 11.4-16.1), respectively. TB patients aged 40-50 years (AOR = 3.65, 95% CI: 1.32-10.14), > 50 years of age (AOR = 5.65, 95% CI: 2.01-16.35), being married (AOR = 3.68, 95% CI: 2.31-7.2), having no formal education (AOR = 3.87, 95% CI: 1.21-9.2), and being overweight or obese (AOR = 3.41, 95% CI: 1.85-8.62) were significantly associated with diabetes mellitus. The prevalence of DM among TB patients in our study was high. Older age, being married, having no formal education, and being overweight or obese were significant risk factors for TB. Integrating TB and DM screening as well as care delivery in clinical practice is essential to achieving the goal of TB control and improving the health outcomes of both diseases.

Interferon Upregulation Associates with Insulin Resistance in Humans

In humans, insulin resistance is a physiological response to infections developed to supply sufficient energy to the activated immune system. This metabolic adaptation facilitates the immune response but usually persists after the recovery period of the infection and predisposes the hosts to type 2 diabetes and vascular injury. In patients with diabetes, superimposed insulin resistance worsens metabolic control and promotes diabetic ketoacidosis. Pathogenic mechanisms underlying insulin resistance during microbial invasions remain to be fully defined. However, interferons cause insulin resistance in healthy subjects and other population groups, and their production is increased during infections, suggesting that this group of molecules may contribute to reduced insulin sensitivity. In agreement with this notion, gene expression profiles (transcriptomes) from patients with insulin resistance show a robust overexpression of interferon- stimulated genes (interferon signature). In addition, serum levels of interferon and surrogates for interferon activity are elevated in patients with insulin resistance. Circulating levels of interferon- γ-inducible protein-10, neopterin, and apolipoprotein L1 correlate with insulin resistance manifestations, such as hypertriglyceridemia, reduced HDL-c, visceral fat, and homeostasis model assessment-insulin resistance. Furthermore, interferon downregulation improves insulin resistance. Antimalarials such as hydroxychloroquine reduce interferon production and improve insulin resistance, reducing the risk for type 2 diabetes and cardiovascular disease. In addition, diverse clinical conditions that feature interferon upregulation are associated with insulin resistance, suggesting that interferon may be a common factor promoting this adaptive response. Among these conditions are systemic lupus erythematosus, sarcoidosis, and infections with severe acute respiratory syndrome-coronavirus-2, human immunodeficiency virus, hepatitis C virus, and Mycobacterium tuberculosis.

Frequency of Lower Lung Field Tuberculosis in Diabetes Mellitus Patients Attending Tertiary Care Hospital in Bangladesh: A Cross-Sectional Study

Background and Aims

People who have diabetes mellitus (DM) are thought to be more susceptible to pulmonary tuberculosis (PTB). Several published comparative investigations have reported that chest x-ray images from PTB with DM are considered atypical due to their frequent involvement of the lower lung field (LLF). This study aimed to investigate the frequency of lower lung field tuberculosis (LLF-TB) in DM and the risk factor of DM for the development of TB.

Methods

This study was a cross-sectional study. PTB was diagnosed by positive sputum acid-fast bacilli (AFB),/Culture,/Gene Xpert MTB/RIF, and DM, which was proven by taking oral hypoglycemic drugs or receiving insulin at the time of hospital admission. Extrapulmonary tuberculosis and seropositive human immunodeficiency virus (HIV) were excluded from this study. A chest x-ray posterior-anterior (P/A) view was done to assess the frequency and patterns of lung involvement. Logistic regression analysis was performed to evaluate the risk factor of DM for the development of TB.

Results

A total of 117 PTB-DM participants were studied in this study. The mean age and frequency of isolated LLF-TB were 53.17 ± 14.38 years and 20.5%, respectively. The prevalence of LLF-TB and other radiological patterns were statistically significantly correlated with smear positivity (83.3% vs. 20.4%), erythrocyte sedimentation rate (ESR) > 50 mm (95.8% vs. 16.1%), and HbA1c > 7 (79.2% vs. 16.1%). Regression analysis showed that the odds ratio (OR) was 6.81 and 3.93 for DM and age (> 40 years) for the development of LLF-TB (p < 0.05).

Conclusion

The frequency of LLF-TB among PTB DM patients was around 1/5th. The development of LLF-TB was substantially associated with DM and age greater than 40 years.

Effect of complicated, untreated and uncontrolled diabetes and pre-diabetes on treatment outcome among patients with pulmonary tuberculosis

BACKGROUND AND OBJECTIVE

Patients with tuberculosis and diabetes have a higher risk of unfavourable anti-tuberculosis treatment outcomes. In the present study, we aimed to evaluate the effects of various diabetes statuses on the outcomes of patients with pulmonary tuberculosis.

METHODS

Among the patients with pulmonary tuberculosis enrolled in the Korea Tuberculosis Cohort (KTBC) registry and the multicentre prospective cohort study of pulmonary tuberculosis (COSMOTB), those with diabetes and complicated diabetes were identified. The primary and secondary outcomes were unfavourable outcomes and mortality, respectively. The effect of diabetes and complicated diabetes on the outcomes was assessed using multivariable logistic regression analysis. Using COSMOTB, subgroup analyses were performed to assess the association between various diabetes statuses and outcomes.

RESULTS

In the KTBC, diabetes (adjusted odds ratio [aOR] = 1.93, 95% CI = 1.64-2.26) and complicated diabetes (aOR = 1.96, 95% CI = 1.67-2.30) were significantly associated with unfavourable outcomes, consistent with the COSMOTB data analysis. Based on subgroup analysis, untreated diabetes at baseline was an independent risk factor for unfavourable outcomes (aOR = 2.72, 95% CI = 1.26-5.61). Prediabetes and uncontrolled diabetes increased unfavourable outcomes and mortality without statistical significance.

CONCLUSION

Untreated and complicated diabetes at the time of tuberculosis diagnosis increases the risk of unfavourable outcomes and mortality.

Efficacy evaluation of Berberis aristata and Silybum marianum fixed dose combination on glycaemic and insulin resistance parameters in adult population: a systematic review and meta-analysis of randomized controlled trials

Background

Diabetes is one of the most prevalent metabolic diseases with high rate of morbidity and mortality. The increased level of blood glucose level and increased insulin resistance is the hallmark of diabetes. Currently, various non-pharmacological and pharmacological therapeutic options are used for lowering the glucose level and improving the insulin activity. The current systematic review and meta-analysis study was conducted to evaluate the efficacy of Berberis aristata and Silybum marianum fixed dose nutraceutical combination on serum glucose and glycated haemoglobin level and insulin resistance parameters.

Main Body

Randomized controlled trials, identified from three online databases, evaluating the efficacy of Berberis aristata and Silybum marianum fixed dose combination were identified and evaluated as per pre-defined protocol. Quality of studies was evaluated using PEDro scale, and risk of bias was assessed using Cochrane Risk of Bias Tool. Pooled effect was reported as mean difference (MD) and 95% confidence interval, while the complete study was conducted as per PRISMA and Cochrane guidelines. After complete literature screening and evaluation process, seven studies were included in the final analysis. Data of 825 participants (active group: 416 participants and control group: 409 participants) were utilized for the statistical analysis. All included studies (except one) were of good quality. Supplementation of fixed dose combination significantly reduced glucose level (MD: − 5.26 mg/dl; p = 0.02) and glycated haemoglobin (HbA1c) level (MD: − 0.69%; p < 0.0001) as compared to control therapy, while greater insulin resistance reduction was observed in active group and the difference approached significance (MD: − 0.64 HOMA-IR score; p = 0.08). Risk of bias analysis revealed some concerns regarding biasness (mainly due to randomization, outcome measurement and selected reporting biasness). All included studies had moderate risk of biasness. Sensitivity analysis revealed effect of particular study on overall heterogeneity observed, while neither significant publication bias nor any missing study was observed.

Conclusion

The results of current study suggest that B. aristata and S. marianum fixed dose combination is effective in improving glycaemic and insulin parameters and can be effective in diabetic population. The observed sensitivity of certain studies on overall heterogeneity and the moderate risk of biasness warrants further well-designed clinical studies to strengthen the results of current study.

Association between diabetes mellitus and cause of death in patients with tuberculosis: A Korean nationwide cohort study

Despite its significant impact on mortality, tuberculosis (TB)-diabetes mellitus (DM) co-prevalence has not been well-elucidated for the cause of death. We investigated the impact of DM on TB-related and non-TB-related deaths in patients with TB. This retrospective nationwide cohort study included patients diagnosed with TB between 2011 and 2017 in South Korea. We performed Fine and Gray regression model analyses to assess the mortality risk of DM classified by cause of death. Of 239,848 patients, 62,435 (26.0%) had DM, and 20,203 died during anti-TB treatment. Of all deaths, 47.9% (9,668) were caused by TB, and the remaining 52.1% (10,535) was attributed to various non-TB-related causes. The mortality rate was higher in the DM than in the non-DM groups in both men and women. DM was associated with a higher risk of TB-related (adjusted hazard ratio [aHR] 1.07, 95% confidence interval [CI] 1.01-1.13) and non-TB-related (aHR 1.21, 95% CI 1.15-1.27) deaths in men; however, only a higher risk of non-TB-related deaths (aHR 1.29, 95% CI 1.20-1.38) in women. Our findings indicate that DM is independently associated with a greater risk of death during anti-TB treatment among patients with TB for both TB-related and non-TB-related deaths.