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- Title
Diabetes Mellitus Among Pulmonary Tuberculosis Patients From 4 Tuberculosis-endemic Countries: The TANDEM Study.
- Authors
Ugarte-Gil, Cesar; Alisjahbana, Bachti; Ronacher, Katharina; Riza, Anca Lelia; Koesoemadinata, Raspati C; Malherbe, Stephanus T; Cioboata, Ramona; Llontop, Juan Carlos; Kleynhans, Leanie; Lopez, Sonia; Santoso, Prayudi; Marius, Ciontea; Villaizan, Katerine; Ruslami, Rovina; Walzl, Gerhard; Panduru, Nicolae Mircea; Dockrell, Hazel M; Hill, Philip C; Allister, Susan Mc; Pearson, Fiona
- 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.
- Subjects
INDONESIA; PERU; ROMANIA; SOUTH Africa; TUBERCULOSIS epidemiology; AGE distribution; ANTHROPOMETRY; BLOOD sugar; CONFIDENCE intervals; DIABETES; GLYCOSYLATED hemoglobin; REGRESSION analysis; BODY mass index; DATA analysis software; DESCRIPTIVE statistics; SYNDEMICS
- Publication
Clinical Infectious Diseases, 2020, Vol 70, Issue 5, p780
- ISSN
1058-4838
- Publication type
Article
- DOI
10.1093/cid/ciz284