A public-private model to scale up diabetes mellitus screening among people accessing tuberculosis diagnostics in Dhaka, Bangladesh

Abstract

Background: Data are scarce regarding the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients in Bangladesh. This study was undertaken to estimate the number needed to screen (NNS) to identify a case of DM among those with TB symptoms and those with confirmed TB disease, and to identify factors predicting treatment outcomes of TB patients with and without DM.

Methods: Persons attending public-private model screening centres in urban Dhaka for the evaluation of TB were offered free blood glucose testing in addition to computer-aided chest X-ray and sputum Xpert MTB/RIF.

Results: Among 7647 people evaluated for both TB and DM, the NNS was 35 (95% confidence interval (CI) 31-40) to diagnose one new case of DM; among those diagnosed with TB, the NNS was 21 (95% CI 17-29). Among those with diagnosed TB, patients with DM were more likely to have cavitation on chest X-ray compared to those without DM (31% vs 22%). Treatment failure (odds ratio (OR) 18.9, 95% CI 5.43-65.9) and death (OR 2.08, 95% CI 1.11-3.90) were more common among TB patients with DM than among TB patients without DM. DM was the most important predictor of a poor treatment outcome in the classification analysis for TB patients aged 39 years and above.

Conclusions: A considerable burden of DM was found among patients accessing TB diagnostics through a public-private model in urban Bangladesh, and DM was associated with advanced TB disease and a high rate of poor treatment outcome.

Keywords: CAD4TB; Pulmonary TB with diabetes; Screening for diabetes; TB treatment outcome.