Oliveira Hashiguchi Lauren, Ferrer Julius Patrick, Suzuki Shuichi, Faguer Benjamin N, Solon Juan Antonio, Castro Mary Christine, Ariyoshi Koya, Cox Sharon E, Edwards Tansy
Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
School of Tropical Medicine & Global Health, Nagasaki University, Nagasaki, Japan.
PLOS Glob Public Health. 2024 May 2;4(5):e0003156. doi: 10.1371/journal.pgph.0003156. eCollection 2024.
Poor TB treatment outcomes are observed in patients with type 2 diabetes mellitus (DM) comorbidity and glycemic control throughout treatment may play a role. The objective of this study was to investigate glycemic control longitudinally among Filipino adults undergoing TB treatment using mixed-effects linear and logistic regression. Analyses were conducted in 188 DM-TB patients out of 901 enrolled in the Starting Anti-TB Treatment (St-ATT) cohort, with a median baseline glycosylated hemoglobin (HbA1c) of 8.2% (range 4.5-13.3%). Previous versus new DM diagnosis was associated with higher mean HbA1c (worse glycemic control) during treatment, with a smaller effect amongst those with central obesity (coefficient 0.80, 95% confidence interval [CI] 0.26, 1.57, P = 0.043) than amongst those without central obesity (coefficient 3.48, 95% CI 2.16, 4.80, P<0.001). In those with a new DM diagnosis, central obesity was associated with higher blood glucose (coefficient 1.62, 95% CI 0.72, 2.53, P = 0.009). Of 177 participants with ≥2 HbA1c results, 40% had uncontrolled glycemia (≥2 HbA1c results ≥8%). Of 165 participants with ≥3 HbA1c results, 29.9% had consistently-controlled glycemia, 15.3% had initially-uncontrolled glycemia, and 18.6% had consistently-uncontrolled glycemia. Previous versus new DM diagnosis and glucose-lowering medication use versus no use were associated with having uncontrolled versus controlled glycemia (adjusted odds ratio [aOR] 2.50 95%CI 1.61, 6.05, P = 0.042; aOR 4.78 95% CI 1.61,14.23, P<0.001) and more likely to have consistently-uncontrolled versus consistently-controlled glycemia (adjusted relative risk ratio [aRRR] 5.14 95% CI 1.37, 19.20, P = 0.015; aRRR 10.24 95% CI 0.07, 0.95, P = 0.003). Relapse cases of TB were less likely than new cases to have uncontrolled (aOR 0.20 95%CI 0.06, 0.63, P = 0.031) or consistently-uncontrolled (aRRR 0.25 95%CI 0.07, 0.95, P = 0.042) versus controlled glycemia. Those with long-term DM, suggested by previous diagnosis, glucose-lowering medication use and possibly central obesity, may require additional support to manage blood glucose during TB treatment.
在合并2型糖尿病（DM）的患者中观察到较差的结核病治疗效果，并且在整个治疗过程中控制血糖可能会起到一定作用。本研究的目的是使用混合效应线性和逻辑回归纵向研究接受结核病治疗的菲律宾成年人的血糖控制情况。对开始抗结核治疗（St-ATT）队列中901名患者中的188名糖尿病合并结核病患者进行了分析，其糖化血红蛋白（HbA1c）基线中位数为8.2%（范围4.5-13.3%）。既往糖尿病诊断与新诊断糖尿病相比，在治疗期间平均HbA1c更高（血糖控制更差），与无中心性肥胖者相比，中心性肥胖者的这种影响较小（系数0.80，95%置信区间[CI]0.26，1.57，P = 0.043）（系数3.48，95%CI 2.16，4.80，P<0.001）。在新诊断为糖尿病的患者中，中心性肥胖与更高的血糖相关（系数1.62，95%CI 0.72，2.53，P = 0.009）。在177名有≥2次HbA1c检测结果的参与者中，40%的人血糖控制不佳（≥2次HbA1c检测结果≥8%）。在165名有≥3次HbA1c检测结果的参与者中，29.9%的人血糖一直得到控制，15.3%的人最初血糖未得到控制，18.6%的人血糖一直未得到控制。既往糖尿病诊断与新诊断糖尿病以及使用降糖药物与未使用降糖药物与血糖控制不佳与良好相关（调整后比值比[aOR]2.50，95%CI 1.61，6.05，P = 0.042；aOR 4.78，95%CI 1.61，14.23，P<0.001），并且更有可能血糖一直未得到控制与一直得到控制相比（调整后相对风险比[aRRR]5.14，95%CI 1.37，19.20，P = 0.015；aRRR 10.24，95%CI 0.07，0.95，P = 0.003）。结核病复发病例与新病例相比，血糖控制不佳（aOR 0.20，95%CI 0.06，0.63，P = 0.031）或一直未得到控制（aRRR 0.25，95%CI 0.07，0.95，P = 0.042）的可能性较小。那些有长期糖尿病的患者，由既往诊断、使用降糖药物以及可能的中心性肥胖提示，在结核病治疗期间可能需要额外的支持来管理血糖。
