Pardeshi Geeta, Mave Vidya, Gaikwad Sanjay, Kadam Dileep, Barthwal Madhusudan, Gupte Nikhil, Atre Sachin, Deshmukh Sona, Golub Jonathan E, Gupte Akshay
Department of Community Medicine, Grant Government Medical College and Sir J.J. Group of Hospitals, Mumbai, India.
Byramjee Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins University School of Medicine, Baltimore, MD.
Chest. 2024 Feb;165(2):278-287. doi: 10.1016/j.chest.2023.08.026. Epub 2023 Sep 4.
Transient hyperglycemia is seen commonly during TB treatment, yet its association with unfavorable treatment outcomes is unclear.
Does an association exist between glycated hemoglobin (HbA1c) trajectories and TB treatment outcomes?
Adults with pulmonary TB were evaluated prospectively for 18 months after the second HbA1c measurement. HbA1c trajectories during the initial 3 months of treatment were defined as follows: persistent euglycemia, HbA1c < 6.5% at baseline and 3-month follow-up; persistent hyperglycemia, HbA1c ≥ 6.5% at baseline and 3-month follow-up; transient hyperglycemia, HbA1c ≥ 6.5% at baseline and < 6.5% at 3-month follow-up; incident hyperglycemia, HbA1c < 6.5% at baseline and ≥ 6.5% at 3-month follow-up. Multivariable Poisson regression was used to measure the association between HbA1c trajectories and unfavorable treatment outcomes of failure, recurrence, and all-cause mortality.
Of the 587 participants, 443 participants (76%) had persistent euglycemia, 118 participants (20%) had persistent hyperglycemia, and 26 participants (4%) had transient hyperglycemia. One participant had incident hyperglycemia and was excluded. Compared with participants with persistent euglycemia, those with transient hyperglycemia showed a twofold higher risk of experiencing an unfavorable treatment outcome (adjusted incidence rate ratio [aIRR], 2.07; 95% CI, 1.04-4.15) after adjusting for confounders including diabetes treatment, and BMI; we did not find a significant association with persistent hyperglycemia (aIRR, 1.64; 95% CI, 0.71-3.79). Diabetes treatment was associated with a significantly lower risk of unfavorable treatment outcomes (aIRR, 0.38; 95% CI, 0.15-0.95).
Transient hyperglycemia and lack of diabetes treatment was associated with a higher risk of unfavorable treatment outcomes in adults with pulmonary TB.
在结核病治疗期间，短暂性高血糖较为常见，但其与不良治疗结局之间的关联尚不清楚。
糖化血红蛋白（HbA1c）轨迹与结核病治疗结局之间是否存在关联？
对成年肺结核患者在第二次HbA1c测量后的18个月进行前瞻性评估。治疗最初3个月内的HbA1c轨迹定义如下：持续性血糖正常，基线和3个月随访时HbA1c < 6.5%；持续性高血糖，基线和3个月随访时HbA1c≥6.5%；短暂性高血糖，基线时HbA1c≥6.5%且3个月随访时< 6.5%；新发高血糖，基线时HbA1c < 6.5%且3个月随访时≥6.5%。采用多变量泊松回归来衡量HbA1c轨迹与治疗失败、复发及全因死亡等不良治疗结局之间的关联。
在587名参与者中，443名参与者（76%）为持续性血糖正常，118名参与者（20%）为持续性高血糖，26名参与者（4%）为短暂性高血糖。有1名参与者为新发高血糖，被排除在外。与持续性血糖正常的参与者相比，在调整包括糖尿病治疗和体重指数等混杂因素后，短暂性高血糖的参与者出现不良治疗结局的风险高出两倍（调整后的发病率比[aIRR]，2.07；95%置信区间，1.04 - 4.15）；我们未发现与持续性高血糖存在显著关联（aIRR，1.64；95%置信区间，0.71 - 3.79）。糖尿病治疗与不良治疗结局的风险显著降低相关（aIRR，0.38；95%置信区间，0.15 - 0.95）。
短暂性高血糖和未接受糖尿病治疗与成年肺结核患者不良治疗结局的较高风险相关。
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