TY - JOUR
T1 - Diabetes mellitus among pulmonary tuberculosis patients from 4 tuberculosis-endemic countries
T2 - The tandem study
AU - the TANDEM Consortium
AU - Ugarte-Gil, Cesar
AU - Alisjahbana, Bachti
AU - Ronacher, Katharina
AU - Riza, Anca Lelia
AU - Koesoemadinata, Raspati C.
AU - Malherbe, Stephanus T.
AU - Cioboata, Ramona
AU - Llontop, Juan Carlos
AU - Kleynhans, Leanie
AU - Lopez, Sonia
AU - Santoso, Prayudi
AU - Marius, Ciontea
AU - Villaizan, Katerine
AU - Ruslami, Rovina
AU - Walzl, Gerhard
AU - Panduru, Nicolae Mircea
AU - Dockrell, Hazel M.
AU - Hill, Philip C.
AU - Allister, Susan Mc
AU - Pearson, Fiona
AU - Moore, David A.J.
AU - Critchley, Julia A.
AU - van Crevel, Reinout
N1 - Publisher Copyright:
© The Author(s) 2019.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - 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.
AB - 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.
KW - Diabetes
KW - HbA1c
KW - Prevalence
KW - Syndemic
KW - Tuberculosis
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U2 - 10.1093/cid/ciz284
DO - 10.1093/cid/ciz284
M3 - Article
C2 - 30958536
AN - SCOPUS:85079353292
SN - 1058-4838
VL - 70
SP - 780
EP - 788
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 5
ER -