Jerene Degu, Muleta Chaltu, Ahmed Abdurezak, Tarekegn Getahun, Haile Tewodros, Bedru Ahmed, Gebhard Agnes, Wares Fraser
KNCV Tuberculosis Foundation, Technical Division, The Hague, Netherlands.
KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, Ethiopia.
J Clin Tuberc Other Mycobact Dis. 2022 Feb 23;27:100306. doi: 10.1016/j.jctube.2022.100306. eCollection 2022 May.
Tuberculosis (TB) and diabetes mellitus (DM) have negative synergistic impact on each other. Global guidelines recommend collaborative efforts to address this synergy, but implementation has been slow. Part of the reason is lack of adequate evidence on the operational feasibility of existing tools and mechanisms of collaboration. The objective of this study was to assess the yield of DM screening among TB patients using risk scoring tools combined with blood tests as a feasible strategy for early detection to improve TB/DM treatment outcomes.
Between September 2020 and December 2021, we conducted a cross-sectional study among patients receiving TB treatment in public health facilities in Addis Ababa, Ethiopia. Trained health workers collected data on symptoms and risk scoring checklists before testing for random and fasting blood glucose levels. We used logistic regression analyses techniques to determine factors associated with increased DM detection. A receiver-operating characteristic curve was constructed to determine the performance of the risk scoring checklist.
Of 2381 TB patients screened, 197 (8.3%) had DM of which 48.7% were newly diagnosed. Having a family history of DM predicted DM with Odds Ratio (OR) of 5.36 (95% Confidence Interval, [3.67, 7.83]) followed by age ≥ 45 years (OR = 4.64, [3.18, 6.76]). Having one or more "symptoms" of DM was a significant predictor (OR 2.88, 95% CI, 2.06-4.01). Combining risk scores with symptoms predicted DM diagnosis with sensitivity of 94.7%, but specificity was low at 29.4%. In patients with known treatment outcome status, death rate was high.
Almost a half of TB patients with DM did not know their status. A simple tool that combined risk factors with symptoms accurately predicted a subsequent diagnosis of DM. Such tools can help avoid high rates of death among TB patients suffering from DM through early detection.
结核病（TB）和糖尿病（DM）对彼此具有负面协同影响。全球指南建议共同努力应对这种协同作用，但实施进展缓慢。部分原因是缺乏关于现有协作工具和机制的操作可行性的充分证据。本研究的目的是评估使用风险评分工具结合血液检测作为早期检测的可行策略，以改善结核病/糖尿病治疗结果，在结核病患者中进行糖尿病筛查的效果。
2020年9月至2021年12月期间，我们在埃塞俄比亚亚的斯亚贝巴的公共卫生设施中对接受结核病治疗的患者进行了一项横断面研究。经过培训的卫生工作者在检测随机血糖和空腹血糖水平之前，收集了症状和风险评分清单的数据。我们使用逻辑回归分析技术来确定与糖尿病检测增加相关的因素。构建了受试者工作特征曲线以确定风险评分清单的性能。
在2381名接受筛查的结核病患者中，197名（8.3%）患有糖尿病，其中48.7%为新诊断病例。有糖尿病家族史预测患糖尿病的比值比（OR）为5.36（95%置信区间，[3.67, 7.83]），其次是年龄≥45岁（OR = 4.64，[3.18, 6.76]）。有一项或多项糖尿病“症状”是一个显著的预测因素（OR 2.88，95% CI，2.06 - 4.01）。将风险评分与症状相结合预测糖尿病诊断的敏感性为94.7%，但特异性较低，为29.4%。在已知治疗结果状态的患者中，死亡率较高。
几乎一半的糖尿病结核病患者不知道自己的病情。一种将风险因素与症状相结合的简单工具能够准确预测随后的糖尿病诊断。此类工具可通过早期检测帮助避免糖尿病结核病患者的高死亡率。
