[Prevalence of comorbidity tuberculosis and diabetes mellitus in Paraguay, 2016 and 2017Prevalência de comorbidade tuberculose-diabetes mellitus no Paraguai, 2016 e 2017]

[Tuberculosis and diabetes comorbidity in Brazil, 2012-2018: exploratory spatial data analysis and statistical modelingLa comorbilidad tuberculosis-diabetes en Brasil, 2012-2018: análisis exploratorio de la distribución espacial y modelización estadística]

Objetivo.

Descrever a distribuição espacial da comorbidade tuberculose-diabetes e identificar os determinantes sociais da dupla carga no período de 2012 a 2018 no Brasil.

Métodos.

Este estudo ecológico utilizou os municípios como unidade de análise. Incluíram-se todos os casos de tuberculose notificados de 2012 a 2018 ao Sistema de Informação de Agravos de Notificação. Como determinantes, foram analisadas variáveis socioeconômicas de emprego, renda e desenvolvimento e o indicador de cobertura da atenção básica. O índice de Moran global foi calculado para verificar a existência de autocorrelação espacial da comorbidade. O índice de Moran local foi utilizado para delimitar clusters de tuberculose-diabetes: alto/alto (municípios com alta proporção de tuberculose-diabetes cujos vizinhos também apresentaram altas proporções) e baixo/baixo (municípios com proporção abaixo da média, cercados por municípios com baixas proporções).

Resultados.

Observou-se elevação na proporção de tuberculose-diabetes na maioria das regiões brasileiras. Constatou-se autocorrelação espacial da comorbidade tuberculose-diabetes e identificou-se um cluster alto-alto de tuberculose-diabetes reunindo 88 municípios, pertencentes principalmente às regiões Nordeste, Sudeste e Sul, com média de prevalência da comorbidade de 28,04%. As variáveis “percentual da população que vive em domicílios com densidade superior a duas pessoas por dormitório”, “percentual de desemprego de pessoas maiores de 18 anos” e “renda per capita” relacionaram-se à ocorrência da comorbidade.

Conclusão.

Os resultados mostraram uma distribuição não aleatória da comorbidade tuberculose-diabetes, com áreas de alto risco e variáveis explicativas de sua ocorrência. Esses achado reforçam a necessidade de operacionalizar a colaboração entre programas de tuberculose e diabetes, com vistas ao controle tanto de cada agravo isoladamente quanto da sindemia.

Gradient association between pulmonary tuberculosis and diabetes mellitus among households with a tuberculosis case: a contact tracing-based study

Pulmonary tuberculosis (PTB) and diabetes mellitus (DM) remain high morbidity and mortality, especially when they are comorbid with each other. Screening for diabetes mellitus in tuberculosis is essential as the incidence and mortality of DM in the population with PTB are higher than in the general people. We aimed to examine the gradient association of tuberculosis on developing DM, the additional yield and the number needed to screen (NNS) to find a new diabetes case. A cross-sectional study was conducted on 801 tuberculosis cases and 972 household contacts in Guizhou, China, from April 2019 to October 2020. After screening for PTB among contacts, all participants were screened for DM and interviewed. Kendall's tau-b test and proportional odds logistic regression analysis were applied to identify the gradient associations. Among the 1773 subjects, the additional yield of screening was 21.8%. The NNSs of the non-PTB group, the sputum-culture negative and positive groups were 50, 60 and 113, respectively. The gradient incremental establishment of DM and PTB were positively correlated. The general trend on the gradient of DM significantly increased with the gradient increase of PTB. Age 35 years and over, excessive edible oil intake and DM family history were identified as significant predictors of diabetes. Integrated screening for DM targeted to different gradients of PTB combined with associated factors is necessitated to achieve a higher additional yield.

Trend and factors associated with Tuberculosis-Diabetes Mellitus comorbidity in a Northeastern Brazilian municipality

OBJECTIVES

to identify the trend and factors associated with Tuberculosis-Diabetes Mellitus comorbidity in Imperatriz, Maranhão.

METHODS

epidemiological temporal-series study, conducted in a Northeastern Brazilian municipality. The population consisted of Tuberculosis cases with Diabetes Mellitus-associated aggravation notified in the Notifiable Diseases Information System (SINAN) between 2009 and 2018. We determined the prevalence and trend of comorbidity using Prais-Winsten regressions and to identify associated factors employed Poisson regression.

RESULTS

prevalence ranged from 3.23% in 2014 to 19.51% in 2018, with a mean of 11.5% for the period, showing an increasing trend. Age groups 30 to 59 years and ≥ 60 years, education < 8 years, and clinical form of pulmonary Tuberculosis were risk factors for comorbidity.

CONCLUSIONS

The increasing trend of comorbidity and its associated factors alert us to the need to improve customer service at all levels of health care.

Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent

PURPOSE OF REVIEW

Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes.

RECENT FINDINGS

The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.