Castellanos-Joya Martín, Delgado-Sánchez Guadalupe, Ferreyra-Reyes Leticia, Cruz-Hervert Pablo, Ferreira-Guerrero Elizabeth, Ortiz-Solís Gabriela, Jiménez Mirtha Irene, Salazar Leslie Lorena, Montero-Campos Rogelio, Mongua-Rodríguez Norma, Baez-Saldaña Renata, Bobadilla-del-Valle Miriam, González-Roldán Jesús Felipe, Ponce-de-León Alfredo, Sifuentes-Osornio José, García-García Lourdes
Dirección del Programa de Micobacteriosis, Centro Nacional de Programas Preventivos y Control de Enfermedades, México, Distrito Federal, México.
Centro de Investigación sobre Enfermedades Infecciosas, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
PLoS One. 2014 Sep 17;9(9):e106961. doi: 10.1371/journal.pone.0106961. eCollection 2014.
Recently, the World Health Organisation and the International Union Against Tuberculosis and Lung Disease published a Collaborative Framework for the Care and Control of Tuberculosis (TB) and Diabetes (DM) (CFTB/DM) proposing bidirectional screening and joint management.
To evaluate the feasibility and effectiveness of the CFTB/DM in Mexico.
Prospective observational cohort.
15 primary care units in 5 states in Mexico.
Patients aged ≥20 years diagnosed with DM or pulmonary TB who sought care at participating clinics.
The WHO/Union CFTB/DM was adapted and implemented according to official Mexican guidelines. We recruited participants from July 2012 to April 2013 and followed up until March 2014. Bidirectional screening was performed. Patients diagnosed with TB and DM were invited to receive TB treatment under joint management.
Diagnoses of TB among DM, of DM among TB, and treatment outcomes among patients with DM and TB.
Of 783 DM patients, 11 (1.4%) were unaware of their TB. Of 361 TB patients, 16 (4.4%) were unaware of their DM. 95 TB/DM patients accepted to be treated under joint management, of whom 85 (89.5%) successfully completed treatment. Multiple linear regression analysis with change in HbA1c and random capillary glucose as dependent variables revealed significant decrease with time (regression coefficients (β) = -0.660, (95% confidence interval (CI), -0.96 to -0.35); and β = -1.889 (95% CI, -2.77 to -1.01, respectively)) adjusting by sex, age and having been treated for a previous TB episode. Patients treated under joint management were more likely to experience treatment success than patients treated under routine DM and TB programs as compared to historical (adjusted OR (aOR), 2.8, 95%CI 1.28-6.13) and same period (aOR 2.37, 95% CI 1.13-4.96) comparison groups.
Joint management of TB and DM is feasible and appears to improve clinical outcomes.
最近，世界卫生组织和国际防痨和肺部疾病联盟发布了一份结核病（TB）和糖尿病（DM）护理与控制合作框架（CFTB/DM），提议进行双向筛查和联合管理。
评估CFTB/DM在墨西哥的可行性和有效性。
前瞻性观察队列研究。
墨西哥5个州的15个初级保健单位。
年龄≥20岁、在参与研究的诊所就诊且被诊断为DM或肺结核的患者。
根据墨西哥官方指南对世界卫生组织/国际防痨和肺部疾病联盟的CFTB/DM进行调整并实施。我们于2012年7月至2013年4月招募参与者，并随访至2014年3月。进行双向筛查。邀请被诊断为TB和DM的患者在联合管理下接受TB治疗。
DM患者中的TB诊断、TB患者中的DM诊断以及DM和TB患者的治疗结局。
在783例DM患者中，11例（1.4%）未意识到自己患有TB。在361例TB患者中，16例（4.4%）未意识到自己患有DM。95例TB/DM患者接受了联合管理下的治疗，其中85例（89.5%）成功完成治疗。以糖化血红蛋白（HbA1c）变化和随机毛细血管血糖为因变量的多元线性回归分析显示，经性别、年龄和既往TB治疗史校正后，随着时间推移有显著下降（回归系数（β）分别为 -0.660，95%置信区间（CI）为 -0.96至 -0.35；以及β = -1.889，95%CI为 -2.77至 -1.01）。与历史对照组（校正比值比（aOR）为2.8，95%CI为1.28 - 6.13）和同期对照组（aOR为2.37，95%CI为1.13 - 4.96）相比，联合管理下接受治疗的患者比常规DM和TB项目治疗的患者更有可能获得治疗成功。
TB和DM的联合管理是可行的，且似乎能改善临床结局。
