The relationship between hemoglobin A1C levels and sputum conversion time in indonesian patients with new cases of pulmonary tuberculosis

Abstract

Background: Hemoglobin A1c (HbA1c) is a glycated form of hemoglobin and is associated with increased susceptibility to tuberculosis (TB), severity, and resistance to therapy. We aimed to determine the impact of HbA1c levels on sputum conversion time among Indonesian patients with pulmonary TB under the intensive phase of TB treatment. Methods: This prospective cohort study was conducted in patients with new cases of pulmonary TB patients aged ≥15-year-old and had never been diagnosed with type 2 diabetes mellitus (T2DM). The exclusion criteria of this study are pulmonary TB accompanied by T2DM, pregnancy, or coinfected with human deficiency virus. Statistical analysis was performed using Fisher's exact test to find the relative risk of all variables. We also performed power analysis to check the sample sufficiency. Results: One hundred and twenty-three patients of new cases of pulmonary TB were included in this study; of which 63 females and 60 males. There were 12 patients who had HbA1c levels ≥47.5 mmol/mol. More than half (56.1%) of patients had smear-positive acid-fast bacilli and duration of sputum smear conversion time for more than 2 months was recorded in 11 patients (8.9%). There was a significant relationship between HbA1c levels >47.5 mmol/mol and sputum conversion time >2 months with a relative risk of 6.3 (1.9–39.6), value of P = 0.01. Conclusion: HbA1c levels played an important role toward sputum smear conversion time in patients with new cases of pulmonary TB, and therefore, HbA1c should be considered as an important factor for the outcome in patients receiving anti-TB drugs.