Global Health Institute, University of Antwerp, Antwerp, Belgium.
Department of Public Health, Institute of Tropical Medicine, Sint Rochusstraat 43, 2000, Antwerp, Belgium.
BMC Infect Dis. 2020 Dec 9;20(1):937. doi: 10.1186/s12879-020-05512-7.
There is scarce evidence that tuberculosis (TB) can cause diabetes in those not previously known to be diabetic. Whilst the World Health Organization (WHO) recommends screening for Diabetes Mellitus (DM) at the onset of TB treatment, nevertheless, it remains to be elucidated which patients with TB-associated hyperglycemia are at higher risk for developing DM and stand to benefit from a more regular follow-up. This review aims to firstly quantify the reduction of newly detected hyperglycemia burden in TB patients who are on treatment over time; secondly, determine the burden of TB-associated hyperglycemia after follow-up, and thirdly, synthesize literature on risk factors for unresolved TB-associated hyperglycemia in previously undiagnosed individuals.
We searched PUBMED, EMBASE, SCOPUS, and Global Health for articles on TB-associated hyperglycemia up to September 30th, 2019. Search terms included Tuberculosis and hyperglycemia/DM, and insulin resistance. We appraised studies, extracted data, and conducted a meta-analysis to assess the change of the burden of hyperglycemia in prospective studies. The review is registered in the PROSPERO database (CRD42019118173).
Eleven studies were included in the meta-analysis yielding a total of 677 (27,3%) of patients with newly detected hyperglycemia at baseline. The mean quality score of eligible studies using the Newcastle-Ottawa Quality Assessment Scale was 7.1 out of 9 (range 6-9). The pooled unresolved new cases of hyperglycemia at the end of follow up was 50% (95% CI: 36-64%) and the total pooled burden of hyperglycemia at 3-6 months of follow up was 11% (95% CI: 7-16%), with both estimates displaying a high heterogeneity, which remained significant after performing a sub-analysis by DM diagnostic method and 3 months of follow up. As only 2 studies explored risk factors for unresolved hyperglycemia, no meta-analysis was performed on risk factors.
Our meta-analysis showed that although in half of the patients with newly observed hyperglycemia at baseline, it remained unresolved at a follow-up of 3 to 6 months, the total burden of hyperglycemia is slightly above 10%, 3 months after initiating TB treatment. Studies are warranted to assess whether risk factors including HIV positivity, smoking, and extensive pulmonary TB disease put patients at higher risk for DM.
有证据表明，结核病（TB）不会在以前未被诊断为糖尿病的患者中引起糖尿病。尽管世界卫生组织（WHO）建议在开始治疗结核病时筛查糖尿病（DM），但仍需要阐明哪些与 TB 相关的高血糖患者有更高的风险发展为 DM，并需要更频繁的随访。本综述的目的是首先量化随时间推移接受治疗的 TB 患者中新发现的高血糖负担的减少；其次，确定 TB 相关高血糖的随访后负担；最后，综合关于以前未确诊的个体中与 TB 相关的高血糖未解决的危险因素的文献。
我们在 PUBMED、EMBASE、SCOPUS 和全球卫生数据库中检索了截至 2019 年 9 月 30 日的与 TB 相关的高血糖文献。检索词包括结核病和高血糖/糖尿病、胰岛素抵抗。我们对研究进行评估、提取数据，并进行荟萃分析以评估前瞻性研究中高血糖负担的变化。该综述已在 PROSPERO 数据库（CRD42019118173）中注册。
荟萃分析纳入了 11 项研究，共纳入了 677 例（27.3%）基线时新发现高血糖的患者。使用纽卡斯尔-渥太华质量评估量表对合格研究的平均质量评分是 7.1 分（范围为 6-9 分）。随访结束时未解决的新发生高血糖的汇总发生率为 50%（95%CI：36-64%），随访 3-6 个月时汇总的高血糖总负担为 11%（95%CI：7-16%），这两个估计值都显示出高度异质性，在按 DM 诊断方法和 3 个月随访进行亚分析后仍有显著差异。由于只有 2 项研究探讨了未解决高血糖的危险因素，因此未对危险因素进行荟萃分析。
我们的荟萃分析表明，尽管在基线时新发现高血糖的患者中有一半在随访 3 至 6 个月时仍未解决，但在开始结核病治疗后 3 个月时，高血糖的总负担略高于 10%。需要进一步研究来评估包括 HIV 阳性、吸烟和广泛的肺部 TB 疾病在内的危险因素是否会使患者更易患糖尿病。
