Abstract
BackgroundDiabetes mellitus (DM) increases tuberculosis (TB) risk, and there is increasing concern over the public health implications of the convergence of these two epidemics. Screening for TB among people with DM is now recommended in India.MethodsPeople with DM seeking care at a large public sector tertiary care hospital clinic in Pune, India, were screened for TB from June 2015 to May 2016. All consenting people with DM were screened for TB at each clinic visit using a five-item, WHO-recommended questionnaire and those with TB symptoms and/or risk factors were tested for active TB using sputum smear microscopty, Xpert® MTB/RIF and TB culture. Categorical data and continuous variables were summarized using descriptive statistics. The x2 test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively.ResultsAmong 630 adults approached for screening, median age was 60 (interquartile range (IQR), 57–64) years and 350 (56%) were females. Median hemoglobin A1c (HbA1c) was 8.7% (IQR, 6.7–9.9) and 444 (70.5%) were poorly controlled DM (HbA1c > 7). Forty-four (7%) had prior history of TB but the proportion with TB risk factors at screening was low (<5%). While 18% of participants reported any TB symptoms, none of these patients were diagnosed with culture confirmed TB.ConclusionsOur study failed to yield any active TB cases using a WHO-recommended questionnaire among people with DM. High TB risk populations among people with DM must be identified if TB screening is to be feasible in settings such as India where the DM epidemic continues to rise.
Highlights
Diabetes mellitus (DM) increases tuberculosis (TB) risk, and there is increasing concern over the public health implications of the convergence of these two epidemics
Both the Bali declaration and the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD) joint statement supported a collaborative framework that recommended bidirectional screening including active TB case finding among people with DM [6, 7]
We present a study that aimed to screen for prevalent TB and TB risk factors among people with DM in western India using WHO recommended TB screening questionnaire [1]
Summary
Diabetes mellitus (DM) increases tuberculosis (TB) risk, and there is increasing concern over the public health implications of the convergence of these two epidemics. DM increases TB risk by at least 3-fold and DM burden is increasing, there have been grave concerns that the DM epidemic may slow the decline of global TB incidence and may hinder the goal of achieving the global milestones of a 50% reduction in TB incidence and 75% reduction in TB deaths by 2025 [3,4,5] Both the Bali declaration and the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD) joint statement supported a collaborative framework that recommended bidirectional screening including active TB case finding among people with DM [6, 7]. With an estimated over two million new cases annually, India accounts for 18% of the
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