Abstract
BackgroundA bi-directional interaction between diabetes mellitus and tuberculosis is well established and has been likened to that between HIV and TB. Whereas HIV screening is standard of care test in sub Saharan Africa TB programs, the same is not true for diabetes mellitus (DM). Sub Saharan Africa, a region with high TB infection rates, is going through an epidemiological transition with rapidly rising prevalence of diabetes.We aimed at characterizing TB patients with DM in order to identify factors associated with TB-DM dual disease among patients attending TB clinics in Dar es Salaam.MethodsA cross-sectional study was conducted between September 2016 and January 2017 among patients attending TB clinics in Dar es Salaam. We collected socio-demographic characteristics, anthropometric measurements and screened for diabetes by measuring fasting blood glucose that was followed by a 2 h postprandial glucose for participants with impaired fasting blood glucose. We examined for socio-demographic and clinical factors associated with diabetes using logistic regression analysis.ResultsOf the 660 enrolled participants with TB, 25 (3.8%) were on treatment for diabetes while 39 (6.1%) and 147 (23%) of the remaining 635 participants were ultimately diagnosed with DM and impaired fasting blood glucose respectively. The overall prevalence of DM was 9.7% (64/660). Independent risk factors for diabetes included: age > 44 years {OR 4.52, 95% CI: [1.28–15.89]}; family history of diabetes {OR 3.42, 95% [CI 1.88–6.21]}.HIV sero-positive TB patients were less likely to have DM compared to those who were HIV sero-negative {OR 0.35, 95% CI [0.17–0.73]}.ConclusionsScreening for diabetes should be advocated for TB patients aged above 44 years and/or with a family history of diabetes. HIV sero-negative TB patients were more likely to have DM compared to those who were HIV sero-positive. Further studies are needed to confirm this observation and the underlying factors.
Highlights
The prevalence of diabetes worldwide has increased by about 20% in the past three decades with large rates in low and middle income countries [1, 2]
Screening TB patients for diabetes mellitus (DM) and vice versa should result in better control of both diseases, as this would aid in early detection and treatment that would result in better outcomes
Statistical methods The total number of participants recruited to estimate the prevalence of diabetes was based on the sample size estimation formula with an estimated prevalence of diabetes among TB patients to be 16.7% [19], type I error at 5 and 3% precision that amounted to 594 participants
Summary
Ethics statement Ethical approval was obtained from the Muhimbili University of Health and Allied Science institutional review board approval number MU/PGS/SAEC/Vol.XVI/. Patients who were newly diagnosed with diabetes during this study were referred to a diabetic clinic to receive standard of care treatment for diabetes. All participants with impaired fasting blood glucose were given 75 mg of oral glucose that was followed by a two-hour postprandial blood glucose measurement using standard ACCU-CHECK blood glucose meter. Statistical methods The total number of participants recruited to estimate the prevalence of diabetes was based on the sample size estimation formula with an estimated prevalence of diabetes among TB patients to be 16.7% [19], type I error at 5 and 3% precision that amounted to 594 participants. For the multivariate and univariate model, risks were calculated and summarized as odds ratios and 95% confidence intervals significance level was set as a p value of < 0.05 in the multivariate analysis model
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