The change in blood glucose levels in tuberculosis patients before and during anti-tuberculosis treatment in China

Yan Lin,Yanli Yuan,Xin Zhao,Jianmu Liu,Linxi Qiu,Xiaoxin He,Yunlong Bai,Bo Li,Zhong Zeng,Guangxu Yang,Xu Meng,Chunyu Yuan,Hailun Zheng,Wanli Kang,Anthony D Harries

doi:10.1080/16549716.2017.1289737

Abstract

ABSTRACT Objective: We aimed to observe (i) changes in fasting blood glucose (FBG) in tuberculosis (TB) patients before and during anti-TB treatment, (ii) whether FBG levels were stable or unstable and (iii) baseline characteristics associated with an unstable FBG. Method: TB patients consecutively attended six clinics or hospitals. FBG measurements were made at months 0, 2 and 6. Data analysis was performed using the chi-square test and multivariate logistic regression. Results: Of 232 patients without diabetes mellitus (DM) whose initial FBG < 6.1 mmol/L, over 90% maintained FBG < 6.1 mmol/L during treatment and no patient developed DM. Of 17 patients without DM and initial FBG between 6.1 and 6.9 mmol/L, over half had FBG < 6.1 mmol/L during treatment and no patient had DM at the end of treatment. Eight DM patients with already known DM had their FBG controlled at < 7.0 mmol/L during treatment. There were 13 DM patients newly diagnosed with FBG ≥ 7.0 mmol/L, and 69% continued to have FBG ≥ 7.0 mmol/L. After adjustment for confounding, the odds for an unstable FBG were higher for HIV-positive status, already having DM, smoking and coming to hospitals rather than clinics. Conclusion: TB patients who do not have DM based on FBG measurements do not develop DM during anti-TB treatment. Those newly diagnosed with DM on screening in general maintain their DM status with high FBG and need to be better managed.

Highlights

Despite efforts for the last 25 years from the global community to control tuberculosis (TB), the disease remains a major global public health threat
270 TB patients were eligible for this study
It is important to note that the use of fasting blood glucose (FBG) alone to diagnose diabetes mellitus (DM) can underestimate the prevalence of this disease by as much as 50% when compared with gold standard testing using the cumbersome but more accurate oral glucose tolerance test [17]

Summary

Introduction

Despite efforts for the last 25 years from the global community to control tuberculosis (TB), the disease remains a major global public health threat. In 2014, an estimated 9.6 million people developed active TB and 1.5 million people were estimated to have died from the disease [1]. The world has witnessed an escalating epidemic of diabetes mellitus (DM) which has arisen as a consequence of population growth, aging, urbanization and lifestyle changes. Available data suggest that an estimated 415 million people worldwide live with DM and another 318 million people have impaired glucose tolerance, which if left unchecked can progress to DM. People with DM have a significantly higher risk of developing active TB which is 2–3 times higher than in those with no diabetes [3]. DM patients with TB are reported to have worse treatment outcomes compared with patients without DM, with delays in sputum culture conversion, an increased risk of failure or death during anti-TB treatment and an increased risk of recurrent disease after successful completion of anti-TB treatment [4,5,6]

Methods

Results

Discussion

Conclusion