DIABETES MELLITUS AMONG TUBERCULOSIS PATIENTS IN A TERTIARY CARE HOSPITAL OF LAHORE

Rabia Arshed Usmani, Muhammad Ijaz Nasir, Salim Wazir, Zarabia Pervaiz, Taskeen Zahra, Mehwish Akhtar

Abstract


Background: Diabetes is an important risk factor for Tuberculosis (TB) that might affect disease presentation and treatment response but has hitherto been neglected by the clinicians. There is inadequate data on the prevalence of diabetes mellitus (DM) among TB patients in Pakistan. This study was conducted to determine the frequency of TB patients having DM. Methods: In this cross-sectional study, 158 TB patients admitted in Gulab Devi hospital were selected by systematic random sampling technique and data were collected using a pretested questionnaire. All patients underwent anthropometric measurements and baseline investigations. Diabetes was confirmed by determining fasting blood sugar level using cut-off value of 126 mg/dl. Data was entered in Epi-Data-6 and analyzed using Epi-Info. Results: Among 158 patients of tuberculosis, 41 (25.9%) were found to be diabetic, out of which 9 (5.69%) were newly diagnosed with diabetes. Moreover 96 (60.8%) patients were 35–55 years of age. Male patients were 97 (61.4%). Most of the patients belonged to the rural area 118 (74.7%) while 115 (72.8%) patients were illiterate and 139 (88%) had monthly income less than 7000 PKR. Conclusion: The study concludes that among tuberculosis patients with diabetes mellitus, about 5.69% were newly diagnosed during the course of investigation. This raises the concern that importance is not being given to routine screening of tuberculosis patients for diabetes by the clinicians. Health professionals should be updated about the link between diabetes and TB.

Keywords: Diabetes mellitus, tuberculosis, socio-demographic characteristics, concomitant diabetes

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References


World Health Organization. WHO Global TB Report 2013. Geneva: WHO office. Available from:

http://www.who.int/tb/publications/global_report/en

World Health Organization. Tuberculosis Fact Sheet. Fact Sheet 2007. Available from:

http://www.who.int/mediacentre/factsheets/fs104/en/print.

WHO Report: Global Tuberculosis control, surveillance, planning and financing. Country profile Pakistan. Switzerland: WHO;2007:p.125–8.

Leung CC, Lam TH, Chan WM, Yew WW, Ho KS, Leung GM, et al. Diabetic control and risk of tuberculosis: a cohort study. Am J Epidemiol 2008;167:1486–94.

Tatar D, Senol G, Alptekin S, Karakuram C, Aydin M, Coskunol I. Tuberculosis in diabetes: features in an endemic area. Jpn J Infect Dis 2009;62:423–7.

Pablos-Mendez A, Blustein J, Knirsch CA. The role of diabetes mellitus in the higher prevalence of tuberculosis among Hispanics. Am J Public Health 1997;87:574–9.

Perez A, Brown HS, Restrepo BI. Association between tuberculosis and diabetes in the Mexican border and non-border regions of Texas. Am J Trop Med Hyg 2006;74:604–11.

Young F, Wotton CJ, Critchley JA, Unwin NC, Goldacre MJ. Increased risk of tuberculosis disease in people with diabetes mellitus: record-linkage study in a UK population. J Epidemiol Community Health 2012;66:519–23.

Restrepo BI, Camerlin AJ, Rahbar MH, Wang W, Restrepo MA, Zarate I, et al. Cross sectional assessment reveals high diabetes prevalence among newly diagnosed tuberculosis cases. Bull World Health Organ 2011;89:352–9.

Baker MA, Harries AD, Jeon CY, Hart JE, Kapur A, Lonnroth K, et al. The impact of diabetes on tuberculosis treatment outcomes: A systematic review. BMC Med 2011;9:81.

Larsen PR, Kronenberg HM, Melmed S, Polonsky KS, editors. Williams’ textbook of endocrinology. 10th ed. Philadelphia: WB Saunders Company; 2003.

Restrepo BI. Convergence of the tuberculosis and diabetes epidemics: Renewal of old acquaintances. Clin Inf Dis 2007;45:436–8.

Stevenson CR, Forouhi NG, Roglic G, Williams BG, Lauer JA, Dye C, et al. DM and tuberculosis: the impact of the DM epidemic on tuberculosis incidence. BMC Public Health 2007;7:234.

Dixon B. Diabetes and tuberculosis: an unhealthy partnership. Lancet Infect Dis 2007;7:444.

Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047–53.

WHO Global tuberculosis control: surveillance, planning, financing. WHO report 2007.Available from: http://www.who.int/tb/publications/global_report/2007/en/index.html

Goldhaber-Fiebert JD, Jeon CY, Cohen T, Murray MB. Diabetes mellitus and tuberculosis in countries with high tuberculosis burdens: individual risks and social determinants. Int J Epidemiol 2011;40:417–28

Shaikh MA, Singla R, Khan NB, Sharif NS, Saigh MO. Does diabetes alter the radiological presentation of pulmonary tuberculosis. Saudi Med J 2003;24:278–81.

Alisjahbana B, Sahiratmadja E, Nelwa EJ, Purwa AM, Ahmad Y, Ottenhoff TH, et al. The Effect of Type 2 Diabetes Mellitus on the Presentation and Treatment Response of Pulmonary Tuberculosis. Clin Infect Dis 2007;45:428–35.

Ruslami R, Nijland HM, Adhiarta IG, Kariadi SH, Alisjahbana B, Aarnoutse RE, et al. Pharmacokinetics of Antituberculosis Drugs in Pulmonary Tuberculosis Patients with Type 2 Diabetes. Antimicrob Agents Chemother 2010;54:1068–74.

Dooley KE, Tang T , Golub JE , Dorman SE , Cronin W. Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. Am J Trop Med Hyg 2009;80:634–9.

Baghaei P, Marjani M, Javanmard P, Tabarsi P, Masjedi MR. Diabetes mellitus and tuberculosis facts and controversies. J Diabetes Metab Disord 2013;12(1):58.

Treatment of Tuberculosis guidelines. 4th ed. Geneva: World Health Organization; 2010.

Viswanathan V, Kumpatla S, Aravindalochanan V, Rajan R, Chinnasamy C, Srinivasan R, et al. Prevalence of diabetes and pre-diabetes and associated risk factors among tuberculosis patients in India. PLoS ONE 2012;7:e41367.

Global tuberculosis control report, 2006- annex 1 profiles of high burden countries. World Health Organization; 2006.

Lonnroth K, editor. Risk factors and social determinants of TB. World health organization; 2004.


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