Prof. M. Viswanathan Diabetes Research Centre, Royapuram, Chennai, India.
National Institutes of Health-International Centre for Excellence in Research, National Institute for Research in Tuberculosis, Chennai, India.
Diabetes Metab Syndr. 2023 Jul;17(7):102801. doi: 10.1016/j.dsx.2023.102801. Epub 2023 Jun 8.
The aim was to assess the effect of prediabetes on tuberculosis(TB) treatment outcomes.
This is a prospective observational cohort study of 569 eligible new smear positive cases screened for DM between 2014 and 2018 in TB units in North Chennai, South India. Based on study criteria, a total of 187 subjects were included and categorised into two groups: TB with normoglycaemia (groupI) (HbA1c<5.7%) and TB with prediabetes (group II) (HbA1c = 5.7-6.4%) and followed them at 3 and 6 month and treatment outcomes were assessed at the end of the TB treatment.
Total cure rate was 72.7% with no significant difference between the groups. Higher proportion of deaths occurred in group II (6.3%) compared to group I (1.3%) (p = 0.09). At the end of intensive phase of directly observed therapy (DOTS) treatment, about 23.8% were observed to have positive sputum smear in group II compared to 8.6% in group I(p = 0.019). The estimated relative risk to remain as sputum smear positive among people with prediabetes at the end of intensive phase was 3.0(95% CI: 1.2-7.6). There was a significant association found with HbA1c at enrollment and unfavourable TB treatment outcomes (β = 1.38, [odds ratio (95% CI) 3.98(1.65-9.64); p = 0.007].
Death rate was high and there was a delay in sputum conversion among TB patients with prediabetes at the end of the intensive phase of TB treatment. HbA1c at the time of diagnosis of prediabetes was significantly associated with unfavourable TB treatment outcomes.
本研究旨在评估糖尿病前期对结核病（TB）治疗结局的影响。
这是一项前瞻性观察性队列研究，纳入了 2014 年至 2018 年期间在印度南部钦奈北部的结核病单位筛查 DM 的 569 例新涂阳病例，共纳入 187 例符合研究标准的患者，分为两组：血糖正常的结核病组（HbA1c<5.7%）（组 I）和糖尿病前期的结核病组（HbA1c = 5.7-6.4%）（组 II），并在 3 个月和 6 个月时进行随访，在结核病治疗结束时评估治疗结局。
总治愈率为 72.7%，两组间无显著差异。组 II（6.3%）的死亡率明显高于组 I（1.3%）（p = 0.09）。在直接观察治疗（DOTS）强化期结束时，组 II 中有约 23.8%的患者痰涂片仍为阳性，而组 I 中为 8.6%（p = 0.019）。在强化期结束时，糖尿病前期患者痰涂片仍为阳性的估计相对风险为 3.0（95%CI：1.2-7.6）。在 DOTS 强化期结束时，HbA1c 与不良结核病治疗结局之间存在显著关联（β=1.38，[优势比（95%CI）3.98（1.65-9.64）；p = 0.007]）。
糖尿病前期结核病患者在结核病治疗强化期结束时死亡率较高，且痰培养转化延迟。糖尿病前期诊断时的 HbA1c 与不良结核病治疗结局显著相关。
