Impact of diabetes mellitus on tuberculosis treatment outcomes: a cohort study in Bengaluru, India

Authors

  • Kishore Shettihalli Gudegowda Department of Community Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
  • Deepak Murthy H. Jagadish Department of Community Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India
  • Ranganath T. Sobagaiah Department of Community Medicine, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20240108

Keywords:

TB, DM, Treatment outcomes, Comorbidity, Public health

Abstract

Background: Tuberculosis (TB) remains a significant global health challenge, particularly in regions with a high prevalence of diabetes mellitus (DM). This study aims to evaluate the impact of DM on the treatment outcomes of TB patients in Bengaluru, India.

Methods: In this cohort study, we examined 592 patients with smear-positive pulmonary TB, half of whom had a comorbid diagnosis of DM. Conducted in the Bruhat Bengaluru Mahanagara Palike area, the study included patients registered under the national TB elimination programme (NTEP). Data were collected on demographic characteristics, treatment adherence, sputum positivity, and treatment outcomes over six months.

Results: The study revealed a high prevalence of DM among TB patients. Significant associations were observed between DM and various challenges, including higher rates of sputum positivity, poor adherence to anti-TB and anti-diabetic medications, increased adverse drug reactions (ADRs), and a higher default rate. TB patients with DM had a 1.5 times higher risk of unsuccessful treatment outcomes compared to non-diabetics. Furthermore, the risk of poor outcomes, particularly relapse, increased substantially in the TB-DM group during the six-month follow-up.

Conclusions: Our findings highlight the crucial need for integrated TB and DM management strategies. This includes routine DM screening for TB patients, personalized treatment regimens, and enhanced patient education and support. These measures are essential for improving treatment outcomes in TB patients with comorbid DM.

References

World Health Organization. Tuberculosis. Available at: WHO Tuberculosis. Accessed on 13 November, 2023.

Dheda K, Gumbo T, Maartens G, Dooley K, Murray M, Furin J et al. The Lancet Respiratory Medicine Commission: 2019 update: epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant and incurable tuberculosis. Lancet Respiratory Med. 2019;7(9):820-6.

Garg R, Khurana A, Khadanga S. The Monster Tuberculosis in India, Impending Epidemic in COVID-19 Era. J Lab Physicians. 2021;14(1):99-100.

Schaible U, Kaufmann S. Editorial: Reassessing Twenty Years of Vaccine Development against Tuberculosis. Frontiers Immunol. 2018;9.

Mushtaq A. United to end tuberculosis. Lancet Respir Med. 2018;6(11):818-9.

Jain V, Iyengar K, Samy DA, Vaishya R. Tuberculosis in the era of COVID-19 in India. Diabetes Metabol Syndrome. 2020;14:1439-43.

International Diabetes Federation. Facts and figures. Available at: https://www.idf.org/about-diabetes/what-is-diabetes/facts-figures.html. Accessed on 13 November, 2023.

American Diabetes Association’s Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41(1):S1-S159.

Koul P, Bhavsar A, Mir H, Simmerman M, Khanna H. Epidemiology and costs of severe acute respiratory infection and influenza hospitalizations in adults with diabetes in India. J Infect Dev Ctries. 2019;13(3):204-11.

Kumar S, Singh T, Angali N, Prasad R, Sureka RK. Intensive Case Finding of Tuberculosis and Diabetes Mellitus-Bidirectional Screening of Patients Attending a Tertiary Teaching Hospital in Rural Telangana, India. J Clin Diagnostic Res. 2022;16(8).

Jali M, Mahishale V, Hiremath M, Satyanarayana S, Kumar A, Nagaraja S et al. Diabetes mellitus and smoking among tuberculosis patients in a tertiary care centre in Karnataka, India. Publ Heal Action. 2013;3(1):S51-3.

Stubbs B, Siddiqi K, Elsey H, Siddiqi N, Ma R, Romano E et al. Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries. Int J Environmental Res Publ Heal. 2020;18(5):2439.

Arnold M, Beran D, Haghparast-Bidgoli H, Batura N, Akkazieva B, Abdraimova A et al. Coping with the economic burden of Diabetes, TB and co-prevalence: evidence from Bishkek, Kyrgyzstan. BMC Health Services Res 2016;16:118.

Bhargava A, Chatterjee M, Jain Y, Chatterjee B, Kataria A, Bhargava M et al. Nutritional Status of Adult Patients with Pulmonary Tuberculosis in Rural Central India and Its Association with Mortality. PLoS one. 2013;8(10):e77979.

Brown T, Yoder K, Litvintseva AP. Nutrition and tuberculosis: A review of the literature and considerations for TB control programs. Int J Tuberculosis Lung Dis. 2017;21(12):1235-44.

Wang Y, Zhou Y, Chen L, Cheng Y, Lai H, Lyu M et al. Metformin promotes smear conversion in tuberculosis‐diabetes comorbidity and construction of prediction models. J Clin Lab Anal. 2022;36(12):e24755.

Karoli R, Shakya S, Singh P. Vitamin D deficiency in patients with tuberculosis and its correlation with glycemic status. Int J Res Med Sci. 2019;8:239.

Aweis D, Suleiman S. Role of Diabetes Mellitus on Adverse Drug Reaction to Anti-tuberculosis Drugs. J Adv Med Pharm Sci. 2020;22(7):34-9.

Babu LP, Robin N, Babu J, Jose J, George S. Adverse drug reactions among drug-resistant tuberculosis treatment: an observational cohort study. Int J Pharm Pharm Sci. 2021;13(9):50-5.

Downloads

Published

2024-01-25

How to Cite

Gudegowda, K. S., Jagadish, D. M. H., & Sobagaiah, R. T. (2024). Impact of diabetes mellitus on tuberculosis treatment outcomes: a cohort study in Bengaluru, India. International Journal Of Community Medicine And Public Health, 11(2), 764–768. https://doi.org/10.18203/2394-6040.ijcmph20240108

Issue

Section

Original Research Articles