University of Virginia Medical Center, Division of Infectious diseases and International Health, Department of Medicine, Charlottesville, VA, United States of America.
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Enteric and Respiratory Infections, Infectious Diseases Division, Dhaka, Bangladesh.
PLoS One. 2021 Nov 23;16(11):e0260389. doi: 10.1371/journal.pone.0260389. eCollection 2021.
In recent non-pandemic periods, tuberculosis (TB) has been the leading killer worldwide from a single infectious disease. Patients with DM are three times more likely to develop active TB and poor treatment outcomes. Single glycemic measurements at TB diagnosis may inaccurately diagnose or mischaracterize DM severity. Data are limited regarding glycemic dynamics from TB diagnosis through treatment.
Prospective study of glycemia dynamics in response to TB treatment measured glycosylated haemoglobin (HbA1c) in patients presenting to TB screening centres in Bangladesh to determine the prevalence and risk factors of hyperglycemia before and at TB treatment completion.
429 adults with active TB disease were enrolled and divided into groups based on history of DM and initial HbA1c range: normoglycemia, prediabetes, and DM. DM was diagnosed in 37%. At treatment completion,14(6%) patients from the normoglycemia and prediabetes groups had HbA1c>6.5%, thus increasing the prevalence of DM to 39%. The number needed to screen to diagnose one new case of DM at TB diagnosis was 5.7 and 16 at treatment completion in the groups without DM. Weight gain>5% at treatment completion significantly increased the risk of hyperglycemia in the groups without DM at TB diagnosis (95% CI 1.23-26.04, p<0.05).
HbA1c testing prior to and at TB treatment completion found a high prevalence of prediabetes and DM, including a proportion found at treatment completion and commonly in people with a higher percentage of weight gain. Further longitudinal research is needed to understand the effects of TB disease and treatment on insulin resistance and DM complications.
在最近非大流行时期，结核病（TB）已成为全球单一传染病的主要死因。患有糖尿病（DM）的患者发生活动性 TB 的可能性增加三倍，且治疗结局较差。在 TB 诊断时进行单次血糖测量可能无法准确诊断或错误描述 DM 的严重程度。关于从 TB 诊断到治疗期间的血糖动态变化的数据有限。
对孟加拉国 TB 筛查中心就诊的患者进行前瞻性研究，以测量糖化血红蛋白（HbA1c），以了解 TB 治疗过程中血糖动态变化，从而确定 TB 治疗前和治疗完成时高血糖的患病率和危险因素。
共纳入 429 例活动性 TB 患者，并根据 DM 病史和初始 HbA1c 范围将其分为正常血糖、糖尿病前期和 DM 组：正常血糖组、糖尿病前期组和 DM 组。DM 的诊断率为 37%。在治疗完成时，正常血糖和糖尿病前期组的 14（6%）例患者的 HbA1c>6.5%，因此 DM 的患病率增加至 39%。在无 DM 组中，诊断 1 例新 DM 病例需要筛查的人数分别为 5.7 和 16 人。在治疗完成时体重增加>5%显著增加了无 DM 患者在 TB 诊断时发生高血糖的风险（95%CI 1.23-26.04，p<0.05）。
在 TB 治疗前和治疗完成时进行 HbA1c 检测发现，糖尿病前期和 DM 的患病率较高，其中一部分在治疗完成时发现，且常见于体重增加比例较高的人群。需要进一步进行纵向研究，以了解 TB 疾病和治疗对胰岛素抵抗和 DM 并发症的影响。
