The influence of diabetes, glycemic control, and diabetes-related comorbidities on pulmonary tuberculosis

PLoS One. 2015 Mar 30;10(3):e0121698. doi: 10.1371/journal.pone.0121698. eCollection 2015.

Abstract

Background: To assess the influence of diabetes mellitus (DM), glycemic control, and diabetes-related comorbidities on manifestations and outcome of treatment of pulmonary tuberculosis (TB).

Methodology/principal findings: Culture positive pulmonary TB patients notified to health authorities in three hospitals in Taiwan from 2005-2010 were investigated. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C) and diabetic patients were categorized into 3 groups: HbA1C<7%, HbA1C 7-9%, HbA1C>9%. 1,473 (705 with DM and 768 without DM) patients were enrolled. Of the 705 diabetic patients, 82 (11.6%) had pretreatment HbA1C<7%, 152 (21.6%) 7%-9%, 276 (39.2%) >9%, and 195 (27.7%) had no information of HbA1C. The proportions of patients with any symptom, cough, hemoptysis, tiredness and weight loss were all highest in diabetic patients with HbA1C>9%. In multivariate analysis adjusted for age, sex, smoking, and drug resistance, diabetic patients with HbA1C>9% (adjOR 3.55, 95% CI 2.40-5.25) and HbA1C 7-9% (adjOR 1.62, 95% CI 1.07-2.44) were significantly more likely to be smear positive as compared with non-diabetic patients, but not those with HbA1C<7% (adjOR 1.16, 95% CI 0.70-1.92). The influence of DM on outcome of TB treatment was not proportionately related to HbA1C, but mainly mediated through diabetes-related comorbidities. Patients with diabetes-related comorbidities had an increased risk of unfavorable outcome (adjOR 3.38, 95% CI 2.19-5.22, p<0.001) and one year mortality (adjOR 2.80, 95% CI 1.89-4.16). However, diabetes was not associated with amplification of resistance to isoniazid (p = 0.363) or to rifampicin (p = 0.344).

Conclusions/significance: Poor glycemic control is associated with poor TB treatment outcome and improved glycemic control may reduce the influence of diabetes on TB.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Antitubercular Agents / therapeutic use
  • Comorbidity
  • Diabetes Complications / blood*
  • Diabetes Complications / epidemiology
  • Diabetes Complications / therapy
  • Diabetes Mellitus / blood*
  • Diabetes Mellitus / epidemiology
  • Diabetes Mellitus / therapy
  • Female
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Taiwan / epidemiology
  • Treatment Outcome
  • Tuberculosis, Pulmonary / complications*
  • Tuberculosis, Pulmonary / drug therapy
  • Tuberculosis, Pulmonary / epidemiology

Substances

  • Antitubercular Agents
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human

Grant support

The work was supported by Taiwan Centers of Disease Control [grant number a research grant DOH101-DC-1103]. The sponsor of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.