Abstract
BackgroundRadiographic manifestations of pulmonary tuberculosis (TB) in patients with diabetes mellitus (DM) have previously been reported, with inconsistent results. We conducted a study to investigate whether glycemic control has an impact on radiographic manifestations of pulmonary TB.MethodsConsecutive patients with culture-positive pulmonary TB who had DM in three tertiary care hospitals from 2005–2010 were selected for review and compared with a similar number without DM. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C). A pre-treatment chest radiograph was read independently by two qualified pulmonologists blinded to patients’ diabetic status. Films with any discordant reading were read by a third reader.Results1209 culture positive pulmonary TB patients (581 with DM and 628 without DM) were enrolled. Compared with those without DM, TB patients with DM were significantly more likely to have opacity over lower lung fields, extensive parenchymal lesions, any cavity, multiple cavities and large cavities (>3 cm). The relative risk of lower lung field opacities was 0.80 (95% CI 0.46–1.42) for those with DM with A1C<7%, 2.32 (95% CI 1.36 - 3.98) for A1C 7%–9%, and 1.62 (95% CI 1.12–2.36) for A1C>9%; and that of any cavity over no cavity was 0.87 (95% CI 0.46–1.62) for patients with DM with A1C<7%, 1.84 (95% CI 1.20–2.84) for A1C 7%–9%, and 3.71 (95% CI 2.64–5.22) for A1C>9%, relative to patients without DM.ConclusionsGlycemic control significantly influenced radiographic manifestations of pulmonary TB in patients with DM.
Highlights
The International Diabetes Federation has estimated that there were 382 million people living with diabetes mellitus (DM) worldwide in 2013 and the numbers will rise to 592 million by 2035 [1]
Random effects meta-analysis of cohort studies showed that DM was associated with an increased risk of TB, while risk estimated by case-control studies was heterogeneous with odds ratios ranging from 1.16 to 7.83 [2]
We report the results of a study that addressed the association of DM and the influence of glycemic control on radiographic manifestations of tuberculosis
Summary
The International Diabetes Federation has estimated that there were 382 million people living with diabetes mellitus (DM) worldwide in 2013 and the numbers will rise to 592 million by 2035 [1]. Radiographic manifestations of pulmonary TB in patients with DM have previously been reported. Several studies reported that TB patients with DM had an increased frequency of lower lung field lesions as compared TB patients without DM [3,4,5,6,7,8], but others did not [9,10,11]. A major limitation of these studies has been that the number of TB patients with DM assessed was usually small and that the influence of sex and age on radiographic manifestations of pulmonary TB was not consistently addressed. Radiographic manifestations of pulmonary tuberculosis (TB) in patients with diabetes mellitus (DM) have previously been reported, with inconsistent results.
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