Tuberculosis In Diabetic Patients Research Articles

An approach to integrated management of diabetes in tuberculosis patients: Availability and readiness of the health facilities of Bangladesh.

Comorbidity of diabetes mellitus and tuberculosis (TB) is a major public health concern in low- and middle-income countries including Bangladesh. An integrated approach is required for adequate management of diabetes mellitus and TB. The objective of the present study was to investigate the availability and readiness of the TB care centers of Bangladesh toward diabetic patients' management. The present study was conducted based on existing data obtained from the Bangladesh Health Facility Survey (BHFS) 2017. Data collected from a total of 303 facilities providing TB services were retrieved. The outcome variables of the present study were availability and readiness of the TB health facilities for providing diabetes mellitus service. Readiness was measured for four domains: staff and guidelines, equipment, diagnostic facility and basic medicine. The independent variables were: facility level, management authority and location of the facility. Binary and multiple logistic regression models were constructed for both the outcome variables (availability and readiness) to find out their predictors. Services for diabetes mellitus were available in 68% of the TB facilities while high readiness was present in 36% of the facilities. For domain-specific readiness index, readiness for the domains of staff and guidelines, equipment, diagnostic facility and basic medicine was reported in 46%, 96%, 38% and 25% facilities respectively. In the logistic regression model, availability of diabetes mellitus services was better in primary level (aOR 2.62, 95% CI 1.78-4.77) and secondary level (aOR 3.26, 95% CI 1.82-9.05) facilities than community facilities. Similarly, readiness of diabetes mellitus care was also better in these facilities (aOR 2.55, 95% CI 1.05-4.71 for primary and aOR 2.75, 95% CI 1.80-4.32 for secondary facilities). Besides, private TB facilities had better availability (aOR 2.84, 95% CI 1.75-5.89) and readiness (aOR 2.52, 95% CI 1.32-4.29) for diabetes mellitus care. Availability and readiness for providing diabetes mellitus services in TB care providing facilities in Bangladesh is inadequate.

Exploring the accuracy of third-generation Nanopore Sequencing technology for detecting mycobacterium tuberculosis in patients with diabetes mellitus

ObjectiveTo explore the diagnostic value of third-generation nanopore sequencing technology in patients with diabetes mellitus suspected of pulmonary tuberculosis. MethodsSamples, including sputum and bronchoalveolar lavage fluid(BALF), were collected from patients with diabetes mellitus suspected of pulmonary tuberculosis who were admitted from October 2021 to August 2023. Nanopore sequencing, acid-fast bacilli (AFB) smear, mycobacterial solid culture, Xpert MTB/RIF, and DNA detection were performed, and their diagnostic efficacy was compared. ResultsThird-generation nanopore sequencing technology exhibited high accuracy in diagnosing pulmonary tuberculosis in patients with diabetes mellitus. Compared to traditional methods, nanopore sequencing showed significantly improved sensitivity (76.80 %), negative predictive value (30.40 %), coincidence (77.92 %), and diagnostic accuracy (AUC = 0.822). Combined detection with Xpert achieved the highest diagnostic performance, with increased sensitivity (81.20 %), positive predictive value (98.20 %), negative predictive value (35.00 %), coincidence (81.82 %), and AUC (0.843). Although acid-fast staining had limitations, its combination with nanopore sequencing improved screening effectiveness. ConclusionCompared to established diagnostic modalities such as acid-fast staining, mycobacterial solid culture, Xpert MTB/RIF, and DNA detection, third-generation nanopore sequencing technology demonstrates a significant improvement in sensitivity for detecting suspected pulmonary tuberculosis in diabetic patients. Notably, the combined application of nanopore sequencing with Xpert testing offers a further enhancement in diagnostic accuracy.

Predictors for Concurrent Diabetes in Tuberculosis Patients. Perspectives from Two Mining Districts of Eastern Tribal State Jharkhand, in India.

Tuberculosis and diabetes both diseases are present in large numbers in the country and we are major contributors to both globally. With the objective to understand the various traits of patients having both tuberculosis and diabetes and to ascertain various possible predictors for such occurrence based on the public health database we carried out this study. We seek answers to questions like they have any effects? Are they having any additive role to play? One-year data from the NIKSHAY portal of both districts were analyzed to look for possible associations and other variable traits. Data were analyzed using standard methods to express data in frequency and percentage. Chi-square test was used to establish association, while step-wise approach was used to calculate univariate and multivariate logistic regression analysis for knowing various predictors. P-value of <0.05 was considered statistically significant. Concurrent diabetes in tuberculosis patients was close to 294 (6%) in the 4933 individuals. In total, 65.2% of the study population were male. Diagnosis of tuberculosis was made most of the time by chest X-ray (49.4%) followed by Microscopy ZN staining and cartridge-based nucleic acid amplification test (CBNAAT). Death was more among diabetics (4.4%) as compared to nondiabetics (3.5%). Diabetes is increasing in tuberculosis patients; improvement in data quality is needed. More research is required to reveal various other reasons that make tuberculosis patients more prone to develop diabetes.

Effect of Rifampicin on the Adhesion Ability and Biofilm of Mycobacterium tuberculosis in diabetic patients Suffering from Tuberculosis

Effect of Rifampicin on the Adhesion Ability and Biofilm of Mycobacterium tuberculosis in diabetic patients Suffering from Tuberculosis

A Bidirectional Immunological Relationship between Diabetes Mellitus and Tuberculosis: A Narrative Review

Tuberculosis (TB) is one of the most common contagious diseases worldwide. Over the past few decades, researchers have made significant efforts to prevent TB. Recent predictions indicate that the prevalence of Diabetes Mellitus (DM) will reach 552 million by 2023 due to ongoing epidemiological changes in several countries across the globe. India is expected to have 62-80 million people with diabetes by 2030, making it the "Diabetes Capital" of the world. Present review discusses the urgent need to understand the mechanisms and implications of DM on the immune systems of TB patients. The correlation between TB and DM has been shown to be bidirectional. Numerous studies have revealed a higher prevalence of diabetes in TB patients, as their immune systems are compromised. TB patients with DM experience progressive deficits in both innate and adaptive immune cell activity, reducing their ability to suppress Mycobacterium tuberculosis (M. tuberculosis) and increasing their risk of developing TB. Increased inflammation and elevated levels of inflammatory cytokines in circulation are characteristics of TB with DM co-morbidity, which indicate the active involvement of the angiogenesis-inflammation nexus. Therefore, to alleviate the burden of both disorders, it would be beneficial to make informed therapy choices by gaining a better understanding of TB immunology in the context of DM.

Impact of diabetes mellitus on treatment outcome of newly diagnosed smear-positive pulmonary tuberculosis patients: A case–Control study

Background: Tuberculosis (TB) and diabetes mellitus (DM) are major public health problems in developing countries such as India. The link of DM and TB is more prominent in these countries where TB is endemic, and the burden of DM is increasing. Studies regarding the effect of DM on smear conversion and treatment outcome of pulmonary TB (PTB) in India are limited. Aims: The study aimed to compare the conversion and treatment success among new smear-positive PTB patients with and without DM. Materials and Methods: A case–control study was conducted in the department of pulmonary medicine of a tertiary care hospital in eastern India between October 2019 and September 2020. All newly diagnosed smear-positive drug-sensitive PTB patients visiting the outdoor or being admitted were identified, and their initial smear status, history of diabetes, and glycemic status were recorded. All the patients were treated with category I regimen of the Revised National TB Control Program. Sputum smear was followed up at the end of intensive phase and at the end of treatment and compared between diabetic and nondiabetic patients. The software SPSS version 16 was used to analyze all the data. Results: Sixty newly diagnosed smear-positive PTB patients with DM and sixty smear-positive PTB without DM were included in this study. Smear conversion was seen in 24 (40%) out of 60 diabetic TB patients and 55 (91.7%) out of 60 nondiabetic TB patients. Treatment success was seen in 40 (66.7%) out of 60 diabetic TB patients and 56 (93.3%) out of the 60 nondiabetic TB patients. Conclusion: Smear conversion and treatment success rate are lower in diabetic TB patients as compared to nondiabetic TB patients.

Prevalence of Diabetes Mellitus among Tuberculosis patients in Bangladesh

Aim: Tuberculosis (TB) and diabetes mellitus continue to be significant public health problems. Diabetes screening of tuberculosis patients will provide early case diagnosis, improved diabetes control, and improved tuberculosis treatment result. The purpose of this study was to ascertain the prevalence and risk factors for diabetes in tuberculosis patients, as well as their influence on the treatment result of tuberculosis. Methods: This cross-sectional study was conducted at Bangladesh's randomly chosen peripheral health institutions. All TB patients above the age of 18 years were checked for diabetes. Age, gender, family history, smoking, and BMI were all considered as risk factors. Results: Out of 165 participants, diabetes was shown to be prevalent in 35% of TB patients. Diabetes was related to advanced age and type of tuberculosis; its origin (pulmonary or extra pulmonary) and socioeconomic level were found to be significant. Conclusion: Diabetes is a common comorbidity among tuberculosis patients. Over the age of 50 years, the risk of this twin morbidity increases significantly. Screening tuberculosis patients for fasting blood sugar values will aid in the early diagnosis of diabetes and will lead to a better prognosis.

Prevalence of Pulmonary Tuberculosis in Diabetic Patients: Epidemiology, Immunological Basis, and Its Amalgamated Management.

Tuberculosis (TB) is one of the most widespread and infectious diseases in the world, which is brought onbyMycobacterium tuberculosis (MTB). Most infection lacks traditional signs. Latent TBis the name given to this ailment. Of these latent infections, 10% become active and cause illness. Fever, night sweats, a prolonged cough with blood-containing mucus, and weight loss are common signs of active TB infection. Diabetes, on the other hand, is a group of metabolic illnesses characterized by elevated serum glucose levels. It is a chronic metabolic condition brought on by a deficiency in insulin secretion or resistance. It is of two types, that is, type 1 and type 2. Among all the cases of diabetes, the occurrence of type 2 is more common and less fatal than type 1. The prevalence of diabetes is currently increasing in low- and middle-income nations. As both diabetes and TB come under the most widespread chronic condition; therefore, their combined effect is evaluated. In recent years, the higher occurrence of TB in patients with hyperglycemia has come to light. People with elevated blood glucose levels exhibit several risk factors that make them more vulnerable to contracting TB. This review provides information on epidemiological data about the prevalence of TB in patients with hyperglycemia. In addition, this paper discusses the immunological underpinnings of TB development in patients with diabetes mellitus and how glycemic management reduces the risk of TB infection. It illustrates how the clinical signs and radiographic evidence of TB differ between people with diabetes and healthy people and mentions diabetes and TB combined management.

A CROSS-SECTIONAL STUDY TO FIND THE PREVALENCE OF IMPAIRED GLUCOSE TOLERANCE IN PULMONARY TUBERCULOSIS PATIENTS

Introduction: Higher prevalence of pulmonary tuberculosis in a diabetic patient is a well-known fact. The inverse relationship i.e. higher prevalence of impaired glucose tolerance in a tuberculous population is also being increasingly realized now and it becomes more relevant due to increased prevalence of DM in general population. Aim/ Objective: To nd the prevalence of abnormal glucose tolerance in pulmonary tuberculosis patients and to correlate the glycaemic parameters with the grades of sputum AFB positivity. Materials &amp; Methods: A hospital based prospective observational comparative study was conducted at a tertiary care hospital. A total of 100 consecutive eligible patients of tuberculosis, were included after taking informed parental consent. Data was analyzed using statistical software SPSS ver. 21. Results: Mean age of the study cases was 42.59 years with 78% males to 22% females. On Oral glucose tolerance test, 56% had normal results while 44% had deranged results. Out of the total 44 cases with deranged results, 13% had IGT and 31% had diabetes. A signicant association was observed between deranged OGTT values and higher sputum grades (p&lt;0.05). Glycemic control as measured by glycated haemoglobin was signicantly associated with grade of sputum positivity. HbA1c levels were 5.98% in cases with “scanty” grade while it was 6.18%, 6.53% and 6.99% in cases with grade +1, +2 and +3 respectively (p&lt;0.05). Conclusion: We observed high prevalence of impaired glucose tolerance and diabetes in tuberculosis patients. Impaired results were signicantly associated with higher degree of sputum positivity. We thus recommend diabetes screening in all TB patients by either HbA1c or OGTT and glucose levels should be measured at least every 2 months after the initiation of anti-tuberculosis treatment.

Questionnaire survey analysis on the screening of tuberculosis among diabetic patients in general hospitals of Hunan Province

Objective: To investigate the development of tuberculosis screening-related tests in general public hospitals(GPHs) of different levels in Hunan Province and the"awareness and practice of screening tuberculosis in diabetic patients"by doctors directly involved in diabetes diagnosis and treatment in the hospitals, aiming to provide reference for the formulation of the tuberculosis-diabetes joint prevention and control activity plan based on our national conditions. Methods: Stratified sampling was used to select 43 GPHs at three different levels in Hunan province: 14 tertiary GPHs, 13 secondary GPHs, and 16 primary GPHs. 284 endocrinologists working in enrolled hospitals were invited to participate in the on-site questionnaire-survey and 277 qualified. The study used SPSS 22.0 statistical software to analyze the data. The prevalence rate of tuberculosis screening test among hospitals at all levels was compared by chi-square test, and logistic regression was used to analyze the related factors affecting doctors' screening awareness. P≤0.05 was considered statistically significant. Results: The allocation of digital X-ray cameras, tuberculin skin tests, sputum acid-fast bacillus smears, sputum cultures for Mycobacterium tuberculosis, and interferon-gamma release assays in the 43 GPHs were 90.7% (39/43), 72.1% (31/43), 55.8% (24/43), 34.9% (15/43), 27.9% (12/43) with significant differences between the different hospital levels(P<0.05). 173 endocrinologists considered it necessary to proactively initiate tuberculosis screening for patients at first diagnosis. When admitting patients, 197 endocrinologists chose tuberculosis screening only for diabetes mellitus patients with suspected tuberculosis symptoms. The most possible reasons why diabetes mellitus patients wouldn't undergo tuberculosis screening were"patients refused(76.5%, 212/277)","patients didn't complain of the symptom(46.9%, 130/277)", and"tuberculosis screening-related tests haven't been conducted in the hospital(35.7%, 99/277)". Conclusions: Although endocrinologists displayed some tuberculosis-related knowledge and awareness of the need for proactive tuberculosis screening, the actual screening rate in the clinical setting was low. This may be related to multiple factors, including those of patients, doctors, and medical institutions.

Subjects With Diabetes Mellitus Are at Increased Risk for Developing Tuberculosis: A Cohort Study in an Inner-City District of Barcelona (Spain).

BackgroundTuberculosis is the leading cause of mortality from lung infectious disease worldwide in recent years, and its incidence has re-emerged in large cities in low-incidence countries due to migration and socioeconomic deprivation causes. Diabetes mellitus and tuberculosis are syndemic diseases, with diabetes being considered a risk factor for developing tuberculosis.ObjectiveTo investigate whether diabetic patients were at increased risk of tuberculosis living in an inner-district of a large city of northeastern Spain.MethodsObservational matched retrospective cohort study based on clinical records from the population of the lowest socioeconomic status in Barcelona (Ciutat Vella district). A cohort including patients with type 1 and type 2 diabetes mellitus in 2007 and new cases until 2016 (8004 subjects), matched 1:1 by sex and age with a non-diabetic cohort. Follow-up period was until December 31st 2018. We evaluated the risk of developing tuberculosis in diabetic patients compared to non-diabetic patients during the follow up period. We used time-to-event analysis to estimate the incidence of tuberculosis, and competing risks regression by clusters and conditional Cox regression models to calculate the hazard ratio (HR) and its 95% confidence intervals (CI).ResultsAmong the 16,008 included subjects, the median follow-up was 8.7 years. The mean age was 57.7 years; 61.2% men and 38.8% women in both groups. The incidence of tuberculosis was 69.9 per 100,000 person-years in diabetic patients, and 40.9 per 100,000 person-years in non-diabetic patients (HR = 1.90; CI: 1.18–3.07). After adjustment for the country of origin, chronic kidney disease, number of medical appointments, BMI, alcoholism and smoking, the risk remained higher in diabetic patients (1.66: CI 0.99–2.77). Additionally, subjects from Hindustan or with a history of alcohol abuse also showed a higher risk of developing tuberculosis (HR = 3.51; CI:1.87–6.57, and HR = 2.73; CI:1.22–6.12 respectively).ConclusionPeople with diabetes mellitus were at higher risk of developing tuberculosis in a large cohort recruited in an inner-city district with a high incidence for this outcome, and low socioeconomic conditions and high proportion of migrants. This risk was higher among Hindustan born and alcohol abusers.

Impact of diabetes mellitus on rifampicin's plasma concentration and bioavailability in patients with tuberculosis: A systematic review and meta-analysis study

To assess the impact of diabetes mellitus on plasma concentration and bioavailability of rifampicin. Web of Science, Cochrane Library, PubMed and Scopus databases were screened until September 2020 on studies reported rifampicin's plasma concentration, bioavailability among diabetic tuberculosis patients and non-diabetic tuberculosis patients. According to the presence or absence of heterogeneity, the pooled estimate was operated by a random or fixed effect model. Sensitivity analysis or subgroup analysis were conducted. Attributed risk fraction of diabetes mellitus in the incidence of low rifampicin's plasma concentration 2-h after administration was calculated. Seventeen studies including 3478 tuberculosis patients were included in this study. Diabetic tuberculosis patients had 1.59 folds incidence of low rifampicin's plasma concentration 2-h after administrations (risk ratio 1.59, 95% confidence interval (1.16, 2.19), p = 0.004) and lower rifampicin's plasma concentration 2-h after administrations (mean difference -1.4, 95% confidence interval (-2.65,-0.15), p = 0.03) compared with non-diabetic tuberculosis patients. The attributed risk fraction of diabetes mellitus in the incidence of low rifampicin's plasma concentration 2-h after administration was 37%. There were no significant difference in rifampicin's maximum plasma concentration, event of low maximum plasma concentration, bioavailability and half-life between both groups. Diabetes mellitus attributed with 37% of low rifampicin's plasma concentration 2-h after administration but not influenced rifampicin's maximum plasma concentration, bioavailability and half-life. The negative effect of diabetes on plasma concentration 2hours after administration was influenced by diabetes management, income level, type of tuberculosis and its recurrence.

Frequency of Latent Tuberculosis Infection in Patients with Type 2 Diabetes referred to Shahid Rahimi Hospital in Khorramabad City with Tuberculin Skin Test in 2018-2020

Introduction: Tuberculosis is the leading cause of death from infectious diseases worldwide. Diabetes has been suggested as an important risk factor for tuberculosis. To date, few studies have examined the association between diabetes and tuberculosis. In this study, the prevalence of latent tuberculosis in diabetic patients was investigated.&#x0D; Methods: In this study, 195 patients with type 2 diabetes were studied in a cross-sectional study to diagnose latent tuberculosis infection with a tuberculin skin test. Individuals with symptoms of active tuberculosis were excluded from the study, and individuals with a positive tuberculin test were evaluated for active tuberculosis by chest x-ray. For analyzing the data, SPSS software version 16 was run, a t-test was used to analyze quantitative variables, and for qualitative variables, Chi-square was applied. The significance level of 0.05 was considered for all the results.&#x0D; Results: Out of 195 diabetic patients, 115 patients were referred for tuberculin test results. 43 out of 115 patients (37.39%) had an induration diameter greater than or equal to 5 mm, 29 patients (25.21%) had an induration diameter greater than or equal to 8 mm, and 3 patients (2.61%) had an induration diameter greater than or equal to 10 mm (Positive tuberculin test) (p&gt;0.05).&#x0D; Conclusion: False tuberculin skin test results can hide the true prevalence of latent tuberculosis infection. The sensitivity of the tuberculin test decreases in immunocompromised patients and leads to limitations in assessing the prevalence of latent tuberculosis infection. Although not enough information was available in this study to establish a significant association between diabetes and latent tuberculosis infection, further studies will help to investigate this association.

The relationship between computed tomography appearance of pulmonary tuberculosis and blood glucose levels in 763 diabetes mellitus patients with pulmonary tuberculosis: a comparative study

IntroductionGlucose tolerance is often impaired in pulmonary tuberculosis (TB) patients. We aimed to explore the relationship between computed tomography (CT) findings of TB and blood glucose levels in diabetes mellitus (DM) patients.Methods763 diabetes mellitus patients with pulmonary tuberculosis (DMTB) from March 2015 to March 2018 were selected and their clinical data were retrospectively evaluated. CT appearance of DMTB was reviewed and compared according to blood glucose levels and CT scores. TB scores were calculated according to the combination of typical and atypical CT appearance. The relationship between blood glucose levels and CT scores was analyzed via Pearson correlation coefficient.ResultsTB lesions mainly occurred in the left lung and the lower lobes in the DMTB patients. Nodules and cavities are the main typical complications in these DMTB patients, and especially the number and size of cavities predominantly contribute to CT scan scores. The size of cavities (diameters (cm), median (95% CI of median)) was 0.72 (0.66–0.77), 1.20 (1.09–1.28), and 3.45 (2.92–3.94) from the low-, middle- and high-CT-score groups, respectively. The patients with high CT scores had a higher level of fasting plasma glucose (mean 13.48 mM, 95% CI of median 12.56–14.44 mM) than the patients in the low-CT-score (mean 8.73 mM, 95% CI of median 8.49–9.36 mM) and middle-CT-score groups (mean 10.16 mM, 95% CI of median 9.89–10.49 mM) (P < 0.0001). CT scores have a consistent relationship with the levels of blood glucose (rho = 0.60, P < 0.0001).ConclusionsCT appearance stands for the severity of tuberculosis and is closely associated with blood glucose levels in diabetic TB patients.

A Blunted GPR183/Oxysterol Axis During Dysglycemia Results in Delayed Recruitment of Macrophages to the Lung During Mycobacterium tuberculosis Infection.

BackgroundWe previously reported that reduced GPR183 expression in blood from tuberculosis (TB) patients with diabetes is associated with more severe TB. MethodsTo further elucidate the role of GPR183 and its oxysterol ligands in the lung, we studied dysglycemic mice infected with Mycobacterium tuberculosis (Mtb).ResultsWe found upregulation of the oxysterol-producing enzymes CH25H and CYP7B1 and increased concentrations of 25-hydroxycholesterol upon Mtb infection in the lungs of mice. This was associated with increased expression of GPR183 indicative of oxysterol-mediated recruitment of GPR183-expressing immune cells to the lung. CYP7B1 was predominantly expressed by macrophages in TB granulomas. CYP7B1 expression was significantly blunted in lungs from dysglycemic animals, which coincided with delayed macrophage infiltration. GPR183-deficient mice similarly had reduced macrophage recruitment during early infection.ConclusionsTaken together, we demonstrate a requirement of the GPR183/oxysterol axis for positioning of macrophages to the site of infection and add an explanation to more severe TB in diabetes patients.

Evaluation of Active Pulmonary Tuberculosis Among Women With Diabetes

Diabetes is one of the most common non-contagious diseases in the world. This disease is the fourth or fifth cause of death in most developed countries. The relationship between tuberculosis and diabetes had been introduced years ago and diabetes is considered a threatening factor in tuberculosis in the research history. Not only tuberculosis is prevalent among diabetic persons, but also diabetes can affect the appearance of imaging of tuberculosis. This is a kind of analytic study, a case-control study, which was carried out between the years 2014 and 2015 in Zabol City. In this study, the radiographic findings from the patients suffering from pulmonary tuberculosis in diabetic patients and not diabetic patients are compared. These radiographic were handed to a radiologist and the radiologic findings of these graphs from the anatomic location (upper and lower half of the right and left bellows), Presence or absence of cavities, nodules, density and pleural involvement were recorded and compared with the diabetic and non-diabetic group. After gathering of the data using SPSS software, descriptive statistics were presented in the form of (frequency, percent) graphs and a chi-square test (p<0.05) was used to analyze and comparing of the results of diabetic and un-diabetic patients. The population of the study consisted of Chest radiographs for 124 TB patients which 61 (49.19 %) were suffering from diabetics. In this study, 45 (71.43%) non-diabetic and 42 (65.85%) diabetic patients were women (p=0.7). There were 12 diabetic TB patients (19.67%) and 3 non-diabetic- TB patients (4.76%) with the consolidation of middle part of left lung (p=0.01) and 8 (13.11%) diabetic TB and 1 (1.59%) non-diabetic TB with reticulonodular infiltration of lower part of left lung (p=0.02). There was no significant difference in the rest of the radiographic results. The findings of this study indicate that reticulonodular infiltration and consolidation of lower &middle parts of the lung in TB diabetic patients is more than in TB non-diabetic patients and diabetes can affect the findings of pulmonary tuberculosis radiography.

The impact of diabetes mellitus on the pharmacokinetics of rifampicin among tuberculosis patients: A systematic review and meta-analysis study

Background and aimsDiabetes mellitus has a negative impact on the treatment outcome of tuberculosis, increasing the incidence of treatment failure and relapse. There is a scarcity of knowledge concerning the impact of diabetes mellitus on the pharmacokinetics of rifampicin. This study was conducted to evaluate the impact of diabetes mellitus on the pharmacokinetics of rifampicin among patients with tuberculosis. MethodsWe explored the Web of Science, Cochrane Library, PubMed, and Scopus databases for articles that reported the pharmacokinetic parameters of rifampicin in diabetic and nondiabetic patients with tuberculosis published until September 2020. Based on the presence or absence of heterogeneity, pooled estimates were calculated using a random or fixed effect model. ResultsSeven studies were relevant and included in this study. The Tmax of rifampicin increased in diabetic patients with tuberculosis compared with nondiabetic patients with tuberculosis (MD 0.84, 95% CI (0.32, 1.35), p = 0.002). No significant differences were detected in rifampicin Cmax (MD 0.18, 95% CI (−0.52, 0.88), p = 0.61), AUC0–24 (SMD -0.02, 95% CI (−0.34, 0.30), p = 0.90), Vd (MD -3.89, 95% CI (−11.17, 3.38), p = 0.29), CL (MD -0.13, 95%CI (−0.88, 0.61), p = 0.72), and MRT (MD 1.89, 95% CI (−0.03, 3.81), p = 0.05) between diabetic and nondiabetic patients with tuberculosis. ConclusionDiabetes mellitus increased the Tmax of rifampicin without further impact on other rifampicin pharmacokinetic parameters such as Cmax, AUC0–24, Vd, CL and MRT. Early therapeutic drug monitoring of rifampicin is necessary for diabetic tuberculosis patients.

Faktor yang Memengaruhi Kejadian Tuberkulosis Paru pada Penderita Diabetes Mellitus di Rumah Sakit X

People with diabetes mellitus are at higher risk for developing active tuberculosis. The diabetes mellitus epidemic has increased the incidence of lung tuberculosis. The purpose of this study is to determine factors that affect the incidence of lung tuberculosis in diabetic patients at “X” hospital in 2020. The method used analytic with case-control research design. The sampling technique is purposive sampling and involved 110 respondents using a sample ratio of 1:1 for the case and control groups. The data source in this study is secondary data from the patient’s medical record. The analysis used is chi-square and logistic regression. The variables studied are age, sex, employment, nutritional status, HbA1C levels, and duration of having diabetes mellitus. The result show factors associated with tuberculosis patients are age (p-value=0,038; OR=3,068), sex (p-value=0,022; OR=2,625), nutritional status (p-value=0,013; OR=0,352), and HbA1c level (p-value=0,046; OR= 2,440). Based on the results of the multivariate analyses factor that has more effects is the HbA1C level (Adjusted OR= 3,141; 95%CI= 1,299-7,594). Recommended for diabetic patients to do a healthy diet, regular exercise, comply with diabetes mellitus treatment, and regularly check blood glucose to maintain normal blood glucose levels.

Baseline IL-6 is a biomarker for unfavourable tuberculosis treatment outcomes: a multisite discovery and validation study.

BackgroundBiomarkers of unfavorable tuberculosis treatment outcomes are needed to accelerate new drug and regimen development. Whether plasma cytokine levels can predict unfavorable tuberculosis treatment outcomes is unclear.MethodsWe identified and internally validated the association between 20 a-priori selected plasma inflammatory markers and unfavorable treatment outcomes of failure, recurrence and all-cause mortality among adults with drug-sensitive pulmonary tuberculosis in India. We externally validated these findings in two independent cohorts of predominantly diabetic and HIV coinfected tuberculosis patients in India and South Africa, respectively.ResultsPre-treatment IFN-γ, IL-13 and IL-6 were associated with treatment failure in the discovery analysis. Internal validation confirmed higher pre-treatment IL-6 concentrations among failure cases compared to controls. External validation among predominantly diabetic tuberculosis patients found an association between pre-treatment IL-6 concentrations and subsequent recurrence and death. Similarly, external validation among predominantly HIV coinfected tuberculosis patients found an association between pre-treatment IL-6 concentrations and subsequent treatment failure and death. In a pooled analysis of 363 tuberculosis cases from the Indian and South African validation cohorts, high pre-treatment IL-6 concentrations were associated with higher risk of failure (adjusted odds ratio [aOR]=2.16, 95%CI 1.08-4.33, p=0.02), recurrence (aOR=5.36, 95%CI 2.48-11.57, p<0.001) and death (aOR=4.62, 95%CI 1.95-10.95, p<0.001). Adding baseline IL-6 to a risk-prediction model comprising of low BMI, high smear grade and cavitation improved model performance by 15 percent (C-statistic of 0.66 versus 0.76, p=0.02).ConclusionPre-treatment IL-6 is a biomarker for unfavorable tuberculosis treatment outcomes. Future studies should identify optimal IL-6 concentrations for point-of-care risk prediction.

Prevalence of Diabetes Mellitus among Pulmonary TB Patients in a Tertiary Care Hospital of Ahmedabad City, Gujarat

Introduction: Diabetes Mellitus and Tuberculosis are two major diseases that often present together and complicate each other at many levels. The epidemic growth of Diabetes Mellitus has occurred in developing countries where Tuberculosis (TB) is highly endemic. As a result, Diabetes Mellitus and TB are increasingly present together. Objectives: To estimate the prevalence of diabetes in tuberculosis patients currently on DOTS treatment and to determine the socio-demographic factors associated with it. Method: A cross sectional study was carried out among pulmonary TB patients receiving DOTS treatment. Total 340 patients were included using convenient sampling who received treatment between August and October 2018. Results: Out of 340 patients, 208 (61%) were males and 132 (39%) were females. The prevalence of diabetes in patients of tuberculosis was found to be 11.5%. Among diabetics, 59% had only diabetes and 41% had other co-morbid disease apart from it. About 56.4% of diabetic TB patients were consuming tobacco. Age, Illiteracy, re-treatment regime were significantly associated with presence of diabetes among TB patients.Conclusion: Diabetes was found to be prevalent in 11.5% of the patients of tuberculosis. Diabetes is significantly associated with the severity of TB, old age and literacy of the TB patients in this study.