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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 Glob 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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Ferrer JP, Suzuki S, Alvarez C, Berido C, Caballero M, Caraig B, Flores PI, Juson RJ, Lustresano A, Opinion T, Saavedra M, Verde A, Faguer BN, Cox SE, Solon JA. Experiences, challenges and looking to the future in a clinical tuberculosis cohort in the time of COVID-19 in the Philippines. Trans R Soc Trop Med Hyg 2021; 115:579-582. [PMID: 33693916 PMCID: PMC7989158 DOI: 10.1093/trstmh/trab025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/15/2021] [Accepted: 02/09/2021] [Indexed: 11/30/2022] Open
Abstract
A cohort study of Filipino tuberculosis patients is currently undergoing data collection amidst the coronavirus disease 2019 pandemic. In this article we present the current experiences, challenges and obstacles of our team during this period as we attempt to fulfil our roles and responsibilities in Metro Manila, Cebu and Negros Occidental in the Philippines. Each site had different lockdown restrictions and experienced problems to different degrees. The underlying themes were similar, covering the supply chain, mobility, communication, physical and mental health and disruption of health services due to reallocation of staff. While we maximized the use of mobile devices, logistical challenges remained. Institutional support for the field teams, creative problem solving and resilience are required to adapt in a rapidly changing environment.
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Affiliation(s)
- Julius Patrick Ferrer
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Shuichi Suzuki
- Nagasaki University Graduate School of Tropical Medicine and Global Health, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Cristelyn Alvarez
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Clarinda Berido
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Michelle Caballero
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Bliss Caraig
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Paul Ian Flores
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Romil Jeffrey Juson
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Ann Lustresano
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Trivon Opinion
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Michelle Saavedra
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Ares Verde
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
| | - Benjamin N Faguer
- Nagasaki University Graduate School of Tropical Medicine and Global Health, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Sharon E Cox
- Nagasaki University Graduate School of Tropical Medicine and Global Health, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan.,Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan.,Faculty of Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK
| | - Juan A Solon
- Nutrition Center of the Philippines, 214-215 Commercenter, East Asia Drive cor. Commerce Avenue, Filinvest Corporate City, Alabang Muntinlupa City, 1781, Philippines
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Cox SE, Edwards T, Faguer BN, Ferrer JP, Suzuki SJ, Koh M, Ferdous F, Saludar NR, Garfin AMCG, Castro MC, Solon JA. Patterns of non-communicable comorbidities at start of tuberculosis treatment in three regions of the Philippines: The St-ATT cohort. PLOS Glob Public Health 2021; 1:e0000011. [PMID: 36962076 PMCID: PMC10021424 DOI: 10.1371/journal.pgph.0000011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/20/2021] [Indexed: 11/18/2022]
Abstract
Diabetes and undernutrition are common risk factors for tuberculosis (TB), associated with poor treatment outcomes and exacerbated by TB. Limited data exist describing patterns and risk factors of multiple comorbidities in persons with TB. Nine-hundred participants (69.6% male) were enrolled in the Starting Anti-TB Treatment (St-ATT) cohort, including 133 (14.8%) initiating treatment for multi-drug resistant TB (MDR-TB). Comorbidities were defined as: diabetes, HbA1c ≥6.5% and/or on medication; hypertension, systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg and/or on medication; anaemia (moderate/severe), haemoglobin <11g/dL; and, undernutrition (moderate/severe) body-mass-index <17 kg/m2. The most common comorbidities were undernutrition 23.4% (210/899), diabetes 22.5% (199/881), hypertension 19.0% (164/864) and anaemia 13.5% (121/899). Fifty-eight percent had ≥1 comorbid condition (496/847), with 17.1% having ≥2; most frequently diabetes and hypertension (N = 57, 6.7%). Just over half of diabetes (54.8%) and hypertension (54.9%) was previously undiagnosed. Poor glycemic control in those on medication (HbA1c≥8.0%) was common (N = 50/73, 68.5%). MDR-TB treatment was associated with increased odds of diabetes (Adjusted odds ratio (AOR) = 2.48, 95% CI: 1.55-3.95); but decreased odds of hypertension (AOR = 0.55, 95% CI: 0.39-0.78). HIV infection was only associated with anaemia (AOR = 4.51, 95% CI: 1.01-20.1). Previous TB treatment was associated with moderate/severe undernutrition (AOR = 1.98, 95% CI: 1.40-2.80), as was duration of TB-symptoms before starting treatment and household food insecurity. No associations for sex, alcohol or tobacco use were observed. MDR-TB treatment was marginally associated with having ≥2 comorbidities (OR = 1.52, 95% CI: 0.97-2.39). TB treatment programmes should plan for large proportions of persons requiring diagnosis and management of comorbidities with the potential to adversely affect TB treatment outcomes and quality of life. Dietary advice and nutritional management are components of comprehensive care for the above conditions as well as TB and should be included in planning of patient-centred services.
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Affiliation(s)
- Sharon E Cox
- Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Tansy Edwards
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
- International Statistics and Epidemiology Group, Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Benjamin N Faguer
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | - Julius P Ferrer
- Nutrition Center Philippines, Muntinlupa City, Manila, Philippines
| | - Shuichi J Suzuki
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | - Mitsuki Koh
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | - Farzana Ferdous
- School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan
| | | | | | - Mary C Castro
- Nutrition Center Philippines, Muntinlupa City, Manila, Philippines
| | - Juan A Solon
- Nutrition Center Philippines, Muntinlupa City, Manila, Philippines
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Edwards T, White LV, Lee N, Castro MC, Saludar NR, Faguer BN, Fuente ND, Mayoga F, Ariyoshi K, Garfin AMCG, Solon JA, Cox SE. Effects of comorbidities on quality of life in Filipino people with tuberculosis. Int J Tuberc Lung Dis 2020; 24:712-719. [PMID: 32718405 DOI: 10.5588/ijtld.19.0734] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: We investigated health-related quality of life (HrQoL) in Filipino people undergoing TB treatment, and whether HrQoL was negatively impacted by comorbidity with undernutrition, diabetes (DM) and anaemia.METHODS: Adult participants were enrolled in public facilities in Metro Manila (three sites) and Negros Occidental (two sites). Multivariate linear regression was used to model the four correlated domain scores from a WHOQOL-BREF questionnaire (physical, psychological, social, environmental). A forward-stepwise approach was used to select a final multivariable model with inclusion based on global tests of significance at P < 0.1.RESULTS: In 446 people on drug-susceptible TB treatment, DM and moderate/severe anaemia were not associated with HrQoL. After adjustment for age, sex, education, food insecurity, treatment adherence, inflammation, Category I or II TB treatment, treatment phase, current side effects and inhibited ability to work, moderate/severe undernutrition (body mass index < 17 kg/m²) was associated with lower HrQoL (P = 0.003) with reduced psychological (coefficient: -1.02, 95% CI -1.54 to -0.51), physical (-0.62, 95% CI -1.14 to -0.09) and environmental domain scores (-0.45, 95% CI -0.88 to -0.01). In 225 patients with known HIV status in Metro Manila, HIV was associated with modestly reduced HrQoL (P = 0.014).CONCLUSION: Nutritional status and food insecurity represent modifiable risk factors for poor HrQoL that may be alleviated through interventions.
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Affiliation(s)
- T Edwards
- Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine (LSHTM), London, UK, School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - L V White
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - N Lee
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan, Royal Free Hospital, London, UK
| | | | | | - B N Faguer
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - N D Fuente
- Valladolid Health Center, Valladolid, Negros Occidental
| | - F Mayoga
- Bago City Health Center, Bago City, Negros Occidental, the Philippines
| | - K Ariyoshi
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - A M C G Garfin
- National TB Control Programme, Department of Health, Manila, the Philippines
| | - J A Solon
- Nutrition Center Philippines, Manila
| | - S E Cox
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan, Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan, Faculty of Population Health, LSHTM, London, UK
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White LV, Edwards T, Lee N, Castro MC, Saludar NR, Calapis RW, Faguer BN, Fuente ND, Mayoga F, Saito N, Ariyoshi K, Garfin AMCG, Solon JA, Cox SE. Patterns and predictors of co-morbidities in Tuberculosis: A cross-sectional study in the Philippines. Sci Rep 2020; 10:4100. [PMID: 32139742 PMCID: PMC7058028 DOI: 10.1038/s41598-020-60942-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/19/2020] [Indexed: 12/22/2022] Open
Abstract
Diabetes and undernutrition are common risk factors for TB, associated with poor treatment outcomes and exacerbated by TB. We aimed to assess non-communicable multimorbidity (co-occurrence of two or more medical conditions) in Filipino TB outpatients, focusing on malnutrition and diabetes. In a cross-sectional study, 637 adults (70% male) from clinics in urban Metro Manila (N = 338) and rural Negros Occidental (N = 299) were enrolled. Diabetes was defined as HbA1c of ≥6.5% and/or current diabetes medication. Study-specific HIV screening was conducted. The prevalence of diabetes was 9.2% (54/589, 95%CI: 7.0-11.8%) with 52% newly diagnosed. Moderate/severe undernutrition (body mass index (BMI) <17 kg/2) was 20.5% (130/634, 95%CI: 17.4-23.9%). Forty percent of participants had at least one co-morbidity (diabetes, moderate/severe undernutrition or moderate/severe anaemia (haemoglobin <11 g/dL)). HIV infection (24.4%, 74/303) was not associated with other co-morbidities (but high refusal in rural clinics). Central obesity assessed by waist-to-hip ratio was more strongly associated with diabetes (Adjusted Odds Ratio (AOR) = 6.16, 95%CI: 3.15-12.0) than BMI. Undernutrition was less common in men (AOR = 0.44, 95%CI: 0.28-0.70), and associated with previous history of TB (AOR = 1.97, 95%CI: 1.28-3.04) and recent reduced food intake. The prevalence of multimorbidity was high demonstrating a significant unmet need. HIV was not a risk factor for increased non-communicable multimorbidity.
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Affiliation(s)
- Laura V White
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Tansy Edwards
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Nathaniel Lee
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
- Royal Free Hospital, London, UK
| | - Mary C Castro
- Nutrition Center Philippines, Manila, The Philippines
| | | | | | - Benjamin N Faguer
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
| | - Nelson Dela Fuente
- Valladolid Health Center, Valladolid, Negros Occidental, The Philippines
| | - Ferdinand Mayoga
- Bago City Health Center, Bago City, Negros Occidental, The Philippines
| | - Nobuo Saito
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | - Koya Ariyoshi
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan
| | | | - Juan A Solon
- Nutrition Center Philippines, Manila, The Philippines
| | - Sharon E Cox
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan.
- Institute of Tropical Medicine, Nagasaki University, Nagasaki, Japan.
- Faculty of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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