Prevalence of dysglycemia and clinical presentation of pulmonary tuberculosis in Western India

Citation: Mave V, Meshram S, Lokhande R, Kadam D, Dharmshale S, Bharadwaj R, Kagal A, Pradhan N, Deshmukh S, Atre S, Sahasrabudhe T, Barhwal M, Meshram S, Kakrani A, Kulkarni V, Raskar S, Suryavanshi N, Shivakoti R, Chon S, Selvin E, Gupte A, Gupta A, Gupte N, Golub J. Prevalence of dysglycemia and clinical presentation of pulmonary tuberculosis in Western India. Int J Tuberc Lung Dis. 2017 Dec 1;21(12):1280-1287. doi: 10.5588/ijtld.17.0474. PMCID: PMC6203962

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https://www.ncbi.nlm.nih.gov/pubmed/29297449

SETTING:
Pune, India.

OBJECTIVES:
To estimate the prevalence and risk factors of pre-diabetes mellitus (DM) and DM, and its associations with the clinical presentation of tuberculosis (TB).

DESIGN:
Screening for DM was conducted among adults (age  18 years) with confirmed TB between December 2013 and January 2017. We used multinomial regression to evaluate the risk factors for pre-DM (glycated hemoglobin [HbA1c]  5.7-6.5% or fasting glucose 100-125 mg/dl) and DM (HbA1c  6.5% or fasting glucose  126 mg/dl or random blood glucose > 200 mg/dl or self-reported DM history/treatment) and the association of dysglycemia with the severity of TB disease.

RESULTS:
Among 1793 participants screened, 890 (50%) had microbiologically confirmed TB. Of these, 33% had pre-DM and 18% had DM; 41% were newly diagnosed. The median HbA1c level among newly diagnosed DM was 7.0% vs. 10.3% among known DM (P < 0.001). DM (adjusted OR [aOR] 4.94, 95%CI 2.33-10.48) and each per cent increase in HbA1c (aOR 1.42, 95%CI 1.01-2.01) was associated with >1+ smear grade or 9 days to TB detection.

CONCLUSION:
Over half of newly diagnosed TB patients had DM or pre-DM. DM and increasing dysglycemia was associated with higher bacterial burden at TB diagnosis, potentially indicating a higher risk of TB transmission to close contacts.

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