Effect of Diabetes Mellitus on Tuberculosis Treatment Outcome and Adverse Reactions in Patients Receiving Directly Observed Treatment Strategy in India: A Prospective Study.

Ali Nasir Siddiqui,Khalid Umer Khayyam,Manju Sharma

doi:10.1155/2016/7273935

Ali Nasir Siddiqui, Khalid Umer Khayyam + Show 1 more

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https://doi.org/10.1155/2016/7273935

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Abstract

Despite successful implementation of directly observed treatment, short course (DOTS) in India, the growing number of diabetes mellitus (DM) patients appears to be a cause in the increasing tuberculosis (TB) incidence, affecting their management. In this regard, a prospective study was conducted on DOTS patients in three primary health care centers in urban slum region of South Delhi, India, to evaluate the effect of DM on sputum conversion, treatment outcome, and adverse drug reactions (ADR) due to anti-TB treatment. Eligible TB patients underwent blood glucose screening at treatment initiation. Disease presentation, clinical outcome, and ADRs were compared between patients of TB with and without DM. Out of 316 patients, the prevalence of DM was found to be 15.8%, in which 19.4% and 9.6% were PTB and EPTB patients, respectively. DM patients have observed higher sputum positivity (OR 1.247 95% CI; 0.539–2.886) at the end of 2-month treatment and poor outcome (OR 1.176 95% CI; 0.310–4.457) at the completion of treatment compared with non DM patients. Presence of DM was significantly associated (OR 3.578 95% CI; 1.114–11.494, p = 0.032) with the development of ADRs. DM influences the treatment outcome of PTB patients in our setting and also on the ADR incidence.

Highlights

The bidirectional association between tuberculosis (TB) and diabetes mellitus (DM) is currently one of the major concerns for clinicians, as DM affects the disease presentation and clinical outcome of TB and vice versa [1]
The DM was more in PTB patients (19.4%) as compared to EPTB patients (9.6%)
Our result shows that DM patients were more likely to be male, be of older age, and have higher mean BMI

Summary

Introduction

The bidirectional association between tuberculosis (TB) and diabetes mellitus (DM) is currently one of the major concerns for clinicians, as DM affects the disease presentation and clinical outcome of TB and vice versa [1]. This comorbidity is known since the beginning of the 20th century. The coepidemic is emerging predominantly in resource poor countries where the burden of DM is increasing and TB is highly endemic [3]. India ranks the highest in TB burden with 23% of the global incidence cases in

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