Cesar Ugarte-Gil1,2,3, Bachti Alisjahbana4,5, Katharina Ronacher6,7, Anca Lelia Riza8,9,10, Raspati C Koesoemadinata5,11, Stephanus T Malherbe6, Ramona Cioboata12, Juan Carlos Llontop13, Leanie Kleynhans6, Sonia Lopez14, Prayudi Santoso4,5, Ciontea Marius15, Katerine Villaizan14, Rovina Ruslami5,11, Gerhard Walzl6, Nicolae Mircea Panduru16, Hazel M Dockrell17, Philip C Hill18, Susan Mc Allister18, Fiona Pearson19, David A J Moore3,14, Julia A Critchley19, Reinout van Crevel8. 1. School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú. 2. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 3. TB Centre, London School of Hygiene and Tropical Medicine, United Kingdom. 4. Department of Internal Medicine, Hasan Sadikin Hospital, Bandung, Indonesia. 5. Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia. 6. 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. 7. Translational Research Institute, Mater Research Institute-University of Queensland, Brisbane, Australia. 8. Department of Internal Medicine and Radboud Center of Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands. 9. Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania. 10. Regional Centre for Human Genetics-Dolj, Emergency Clinical County Hospital, Craiova, Romania. 11. Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia. 12. Hospital for Infectious Diseases and Pneumology "Victor Babeș," Craiova, Romania. 13. Hospital de Huaycan, Lima, Perú. 14. Laboratorios de Investigación y Desarrollo, Universidad Peruana Cayetano Heredia, Lima, Perú. 15. Pneumology Hospital Tudor Vladimirescu, Dobrita, jud. Gorj, Bucharest, Romania. 16. 2nd Clinical Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania. 17. Department of Immunology and Infection, London School of Hygiene and Tropical Medicine, United Kingdom. 18. Centre for International Health, University of Otago Medical School, University of Otago, Dunedin, New Zealand. 19. Population Health Research Institute, St Georges, University of London, United Kingdom.
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.
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-DMpatients ranged from 7.4% (Romania) to 11.3% (Indonesia). Compared to those without DM, TB-DMpatients 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.
Authors: Frank Vrieling; Bachti Alisjahbana; Edhyana Sahiratmadja; Reinout van Crevel; Amy C Harms; Thomas Hankemeier; Tom H M Ottenhoff; Simone A Joosten Journal: Sci Rep Date: 2019-12-10 Impact factor: 4.379
Authors: Anouk van Hooij; Maria Tió-Coma; Els M Verhard; Marufa Khatun; Khorshed Alam; Elisa Tjon Kon Fat; Danielle de Jong; Abu Sufian Chowdhury; Paul Corstjens; Jan Hendrik Richardus; Annemieke Geluk Journal: Front Immunol Date: 2020-08-11 Impact factor: 7.561