Kornfeld Hardy, West Kim, Kane Kevin, Kumpatla Satyavani, Zacharias Rajesh Roy, Martinez-Balzano Carlos, Li Wenjun, Viswanathan Vijay
University of Massachusetts Medical School, Worcester, Massachusetts.
University of Massachusetts Medical School, Worcester, Massachusetts.
Chest. 2016 Jun;149(6):1501-8. doi: 10.1016/j.chest.2016.02.675. Epub 2016 Mar 10.
Previous studies reported an association of diabetes mellitus (DM) with TB susceptibility. Many studies were retrospective, had weak diagnostic criteria for DM, and did not assess other comorbidities. The Effects of Diabetes on Tuberculosis Severity (EDOTS) study is addressing these limitations with a longitudinal comparison of patients with TB who are classified as diabetic or normoglycemic according to World Health Organization criteria. We report interim findings after enrolling 159 of a planned 300 subjects.
A cohort study of patients with TB in South India with DM or normoglycemia defined by oral glucose tolerance test (OGTT) and fasting glucose. Glycohemoglobin (HbA1c), serum creatinine, lipids, and 25-hydroxyvitamin D were measured at enrollment. Patients were monitored monthly during TB treatment, and HbA1c measurement was repeated after 3 months.
Of 209 eligible patients, 113 (54.1%) were classified as diabetic, 44 (21.0%) with impaired glucose tolerance, and 52 (24.9%) as normoglycemic. More patients with diabetes were detected by OGTT than by HbA1c. Diabetes was a newly received diagnosis for 37 (32.7%) in the DM group, and their median HbA1c (6.8%) was significantly lower than in those with previously diagnosed DM (HbA1c, 10.4%). Among 129 patients monitored for 3 months, HbA1c declined in all groups, with the greatest difference in patients with a newly received diagnosis of DM.
Early EDOTS study results reveal a strikingly high prevalence of glycemic disorders in South Indian patients with pulmonary TB and unexpected heterogeneity within the patient population with diabetes and TB. This glycemic control heterogeneity has implications for the TB-DM interaction and the interpretation of TB studies relying exclusively on HbA1c to define diabetic status.
既往研究报道糖尿病（DM）与结核病易感性有关。许多研究为回顾性研究，糖尿病诊断标准不严格，且未评估其他合并症。糖尿病对结核病严重程度的影响（EDOTS）研究通过对根据世界卫生组织标准分类为糖尿病或血糖正常的结核病患者进行纵向比较，来解决这些局限性。我们报告了在计划纳入的300名受试者中纳入159名后的中期研究结果。
对印度南部患有结核病且通过口服葡萄糖耐量试验（OGTT）和空腹血糖定义为糖尿病或血糖正常的患者进行队列研究。入组时测量糖化血红蛋白（HbA1c）、血清肌酐、血脂和25-羟基维生素D。在结核病治疗期间每月对患者进行监测，并在3个月后重复测量HbA1c。
在209名符合条件的患者中，113名（54.1%）被分类为糖尿病患者，44名（21.0%）葡萄糖耐量受损，52名（24.9%）血糖正常。通过OGTT检测出的糖尿病患者比通过HbA1c检测出的更多。糖尿病组中有37名（32.7%）为新诊断病例，他们的HbA1c中位数（6.8%）显著低于先前诊断为糖尿病的患者（HbA1c，10.4%）。在129名接受了3个月监测的患者中，所有组的HbA1c均下降，新诊断为糖尿病的患者下降幅度最大。
早期EDOTS研究结果显示，印度南部肺结核患者中血糖紊乱的患病率极高，且糖尿病合并结核病患者群体存在意外的异质性。这种血糖控制的异质性对结核病与糖尿病的相互作用以及仅依靠HbA1c来定义糖尿病状态的结核病研究的解释具有重要意义。
