Diabetes mellitus is associated with increased mortality during tuberculosis treatment: a prospective cohort study among tuberculosis patients in South-Eastern Amahra Region, Ethiopia

Mahteme Haile Workneh, Gunnar Aksel Bjune, Solomon Abebe Yimer, Mahteme Haile Workneh, Gunnar Aksel Bjune, Solomon Abebe Yimer

Abstract

Background: There is growing evidence suggesting that diabetes mellitus (DM) affects disease presentation and treatment outcome in tuberculosis (TB) patients. This study aimed at investigating the role of DM on clinical presentations and treatment outcomes among newly diagnosed TB patients.

Methods: A prospective cohort study was conducted in South-Eastern Amhara Region, Ethiopia from September 2013 till March 2015. Study subjects were consecutively recruited from 44 randomly selected health facilities in the study area. Participants were categorized into two patient groups, namely, patients with TB and DM (TBDM) and TB patients without DM (TBNDM). Findings on clinical presentations and treatment outcomes were compared between the two patient groups. Cox proportional hazard regression analysis was applied to identify factors associated with death.

Results: Out of 1314 TB patients enrolled in the study, 109 (8.3 %) had coexisting DM. TBDM comorbidity [adjusted hazard ratio (AHR) 3.96; 95 % confidence interval (C.I.) (1.76-8.89)], and TB coinfection with human immunodeficiency virus (HIV) [AHR 2.59; 95 % C.I. (1.21-5.59)] were associated with increased death. TBDM and TBNDM patients did not show significant difference in clinical symptoms at baseline and during anti-TB treatment period. However, at the 2(nd) month of treatment, TBDM patients were more symptomatic compared to patients in the TBNDM group.

Conclusions: The study showed that DM is associated with increased death during TB treatment. DM has no association with clinical presentation of TB except at the end of the intensive phase treatment. Routine screening of TB patients for DM is recommended for early diagnosis and treatment of patients with TBDM comorbidity.

Keywords: Amhara Region; Association; Diabetes mellitus; Ethiopia; Symptoms; Treatment outcome; Tuberculosis.

Figures

Fig. 1
Fig. 1
Kaplan-Meier curves for sputum smear conversion comparing TBDM Vs. TBNDM patient groups
Fig. 2
Fig. 2
Kaplan-Meier curves for death comparing TBDM Vs. TBNDM patient groups

References

    1. Niazi AK, Kalra S. Diabetes and tuberculosis: a review of the role of optimal glycemic control. J Diabetes Metab Disord. 2012;11:28. doi: 10.1186/2251-6581-11-28.
    1. World Health Organization. Global tuberculosis report. 2013. . Accessed 7 Aug 2014.
    1. Das P, Horton R. Tuberculosis-time to accelerate progress. The Lancet. 2010; 375(9718):1755–57.
    1. Lönnroth K, Jaramillo E, Williams BG, Dye C, Raviglione M. Drivers of tuberculosis epidemics: The role of risk factors and social determinants. Soc Sci Med. 2009;68:2240–6. doi: 10.1016/j.socscimed.2009.03.041.
    1. Dooely KE, Chaisson RE. Tuberculosis and diabetes mellitus: Convergence of two epidemics. Lancet Infect Dis. 2009;9(12):737–46. doi: 10.1016/S1473-3099(09)70282-8.
    1. Sen T, Joshi SR, Udwadia ZF. Tuberculosis and diabetes mellitus: Merging epidemics. J Assoc Physicians India. 2009;57:399–404.
    1. Restrepo BI, Fisher-Hoch SP, Crespo JG, Whitney E, Perza A, Smith B. Type 2 diabetes and tuberculosis in a dynamic bi-national border population. Epidemiol Infect. 2007;135(3):483–91. doi: 10.1017/S0950268806006935.
    1. Chang JT, Dou HY, Yen CL, Wu YH, Huang RM, Lin HJ, et al. Effect of type 2 diabetes mellitus on the clinical severity and treatment outcome in patients with pulmonary tuberculosis: a potential role in the emergence of multidrug-resistance. J Formos Med Assoc. 2011;110(6):372–81. doi: 10.1016/S0929-6646(11)60055-7.
    1. Carreira S, Costeira J, Gomes C, André JM, Diogo N. Impact of diabetes on the presenting features of tuberculosis in hospitalized patients. Rev Port Pneumol. 2012;18(5):239–43. doi: 10.1016/j.rppneu.2012.04.001.
    1. Shital P, Anil J, Sanjay M, Mukund P. Tuberculosis with diabetes mellitus: clinical-radiological overlap and delayed sputum conversion needs cautious evaluation-prospective cohort study in tertiary care hospital. India J Pulm Respir Med. 2014;4:175.
    1. Dooley KE, Tang T, Golub JE, Dorman SE, Cronin W. Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. Am J Trop Med Hyg. 2009;80(4):634–9.
    1. Baker MA, Harries AD, Jeon CY, Hart JE, Kapur A, Lönnroth K, et al. The impact of diabetes on tuberculosis treatment outcomes: a systematic review. BMC Med. 2011;9:81. doi: 10.1186/1741-7015-9-81.
    1. Singla R, Khan N, Al-Sharif A, Al-Sayegh MO, Shaikh MA, Osman MM. Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients. Int J Tuberc Lung Dis. 2006;10(1):74–9.
    1. Duangrithi D, Thanachartwet V, Desakorn V, Jitruckthai P, Phojanamongkolkij K, Rienthong S, et al. Impact of diabetes mellitus on clinical parameters and treatment outcomes of newly diagnosed pulmonary tuberculosis patients in Thailand. Int J Clin Pract. 2013;67(11):1199–209. doi: 10.1111/ijcp.12215.
    1. Diabetes: the hidden pandemic and its impact on sub-Saharan Africa. Diabetics leadership forum Africa. 2010. . Accessed 25 July 2011.
    1. World Health Organization. Global tuberculosis report. 2014. . Accessed 25 Oct 2015.
    1. Federal Ministry of Health Ethiopia. Guidelines for clinical and programmatic management of TB, leprosy and TB/HIV in Ethiopia. 5th edition. Addis Ababa, 2012; 1-138.
    1. Amare H, Gelaw A, Anagaw B, Gelaw B. Smear positive pulmonary tuberculosis among diabetic patients at the Dessie referral hospital, Northeast Ethiopia. Infect Dis poverty. 2013;2:6. doi: 10.1186/2049-9957-2-6.
    1. Getachew A, Mekonnen S, Alemu S, Yusuf H. High magnitude of diabetes mellitus among active pulmonary tuberculosis patients in Ethiopia. Br J Med Med Res. 2014;4(3):862–72.
    1. Amhara Regional State Health Bureau. Annual health service report. Bahir-Dar, Ethiopia.2007 E.C.
    1. World Health Organization. Treatment of tuberculosis guideline. 4th Edition. WHO/HTM/TB/2009.420
    1. World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycemia. 2006. . Accessed 12 Feb 2013.
    1. Resolution WHA. 44.8. In: Forty-fourth World Health Assembly, Geneva, 6-16 May, 1991. Resolutions and Decisions. Geneva: World Health Organization; 1991 (WHA44/1991/REC/1).
    1. Chiang CY, Bai KJ, Lin HH, Chien ST, Lee JJ, Enarson DA, et al. The influence of diabetes, glycemic control, and diabetes-related comorbidities on pulmonary tuberculosis. PLoS One. 2015;10(3):e0121698. doi: 10.1371/journal.pone.0121698.
    1. Kansal HM, Srivastava S, Bhargava SK. Diabetes mellitus and tuberculosis. JIMSA. 2015;28(1):58–60.
    1. Kapur A, Harries AD. The double burden of diabetes and tuberculosis – public health implications. Diabetes Res Clin Pract. 2013;101(1):10–9. doi: 10.1016/j.diabres.2012.12.001.
    1. Geerlings SE, Hoepelman AIM. Immune dysfunction in patients with diabetes mellitus. FEMS Immunol Med Microbiol. 1999;26:259–65. doi: 10.1111/j.1574-695X.1999.tb01397.x.
    1. Sulaiman SAS, Khan AH, Muttalif AB, Hassali MA, Ahmad N, Iqubal MA. Impact of diabetes mellitus on treatment outcomes of tuberculosis patients in tertiary care setup. Am J Med Sci. 2013;345(4):321–5. doi: 10.1097/MAJ.0b013e318288f8f3.
    1. Prasad P, Gounder S, Varman S, Viney K. Sputum smear conversion and treatment outcomes for tuberculosis patients with and without diabetes in Fiji. Public Health Action. 2014;4(3):159–63. doi: 10.5588/pha.14.0023.
    1. The End TB Strategy. World Health Organization. Global strategy and targets for tuberculosis prevention, care and control after 2015. . Accessed 25 Oct 2015.
    1. World Health Organization/International Union against Tuberculosis and Lung Disease.2011. Collaborative framework for care and control of tuberculosis and diabetes. Geneva: WHO/HTM/TB/2011.15.
    1. Alisjahbana B, Sahiratmadja E, Nelwan EJ, Purwa AM, Ahmad Y, Ottenhoff THM, et al. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin Infect Dis. 2007;45(4):428–35. doi: 10.1086/519841.
    1. NM NNR, NS Mohd, Z WM, D S, NH NR. Factor associated with unsuccessful treatment outcome of pulmonary tuberculosis in Koto Bahru, Kelan. Malays J Public Health Medicine. 2011; 11(1): 6–15.
    1. Yurteri G, Sarac S, Dalkiliç O, Ofluoglu H, Demiröz F. Features of pulmonary tuberculosis in patients with diabetes mellitus: a comparative study. Turkish Respiratory J. 2004;5(1):5–8.
    1. Baghaei P, Tabarsi P, Abrishami Z, Mirsaeidi M, Faghani YA, Mansouri SD, et al. Comparison of pulmonary TB patients with and without diabetes mellitus type II. Tanaffos. 2010;9(2):13–20.
    1. Faurholt-Jepsen D, Range N, PrayGod G, Jeremiah K, Faurholt-Jepsen M, Aabye MG, et al. The role of diabetes on the clinical manifestations of pulmonary tuberculosis. Trop Med Int Health. 2012;17(7):877–83. doi: 10.1111/j.1365-3156.2012.03002.x.
    1. World Health Organization. Guideline: Nutritional care and support for patients with tuberculosis. Geneva: World Health Organization. 2013. . Accessed 26 Sep 2015.
    1. Nijland HMJ, Ruslami R, Stalenhoef JE, Nelwan EJ, Alisjahbana B, Nelwan RHH, et al. Exposure to rifampicin is strongly reduced in patients with tuberculosis and type-2 diabetes. Clin Infect Dis. 2006;43(7):848–54. doi: 10.1086/507543.
    1. Jayakody W, Harries AD, Malhotra S, De Alwis S, Samaraweera S, Pallewatta N. Characteristics and outcomes of tuberculosis patients who fail to smear convert at two months in Sri Lanka. Public Health Action. 2013;3(1):26–30. doi: 10.5588/pha.12.0090.
    1. Kadhiravan T. Adherence and acquired drug resistance in tuberculosis: Wisdom stood on its head. Indian J Chest Dis Allied Sci. 2013;55:9–10.
    1. Fiseha T, Gebru T, Gutema H, Debela Y. Tuberculosis treatment outcome among HIV co-infected patients at Mizan-Aman general hospital, Southwest Ethiopia: a retrospective study. J Bioeng Biomed Sci. 2015;5(1):139.

Source: PubMed

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