Association of diabetes and tuberculosis: impact on treatment and post-treatment outcomes
- María Eugenia Jiménez-Corona1,
- Luis Pablo Cruz-Hervert2,
- Lourdes García-García2,
- Leticia Ferreyra-Reyes2,
- Guadalupe Delgado-Sánchez2,
- Miriam Bobadilla-del-Valle3,
- Sergio Canizales-Quintero2,
- Elizabeth Ferreira-Guerrero2,
- Renata Báez-Saldaña2,
- Norma Téllez-Vázquez2,
- Rogelio Montero-Campos2,
- Norma Mongua-Rodriguez2,
- Rosa Areli Martínez-Gamboa3,
- José Sifuentes-Osornio3,
- Alfredo Ponce-de-León3
- 1 Laboratorios de Biológicos y Reactivos de México (BIRMEX), Ciudad de México, Distrito Federal México, México
- 2 Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México
- 3 Instituto Nacional de Ciencias Médicas y de Nutrición Salvador Zubirán (INCMNSZ) Vasco de Quiroga 15, Ciudad de México, Distrito Federal México, México
- Correspondence to Dr Lourdes García-García, Instituto Nacional de Salud Pública, Av. Universidad # 655, Col. Sta. María Ahuacatitlán, Cuernavaca, Morelos C.P. 62100, México;
- Received 29 February 2012
- Revised 15 October 2012
- Accepted 24 November 2012
- Published Online First 18 December 2012
Objective To determine the clinical consequences of pulmonary tuberculosis (TB) among patients with diabetes mellitus (DM).
Methods We conducted a prospective study of patients with TB in Southern Mexico. From 1995 to 2010, patients with acid-fast bacilli or Mycobacterium tuberculosis in sputum samples underwent epidemiological, clinical and microbiological evaluation. Annual follow-ups were performed to ascertain treatment outcome, recurrence, relapse and reinfection.
Results The prevalence of DM among 1262 patients with pulmonary TB was 29.63% (n=374). Patients with DM and pulmonary TB had more severe clinical manifestations (cavities of any size on the chest x-ray, adjusted OR (aOR) 1.80, 95% CI 1.35 to 2.41), delayed sputum conversion (aOR 1.51, 95% CI 1.09 to 2.10), a higher probability of treatment failure (aOR 2.93, 95% CI 1.18 to 7.23), recurrence (adjusted HR (aHR) 1.76, 95% CI 1.11 to 2.79) and relapse (aHR 1.83, 95% CI 1.04 to 3.23). Most of the second episodes among patients with DM were caused by bacteria with the same genotype but, in 5/26 instances (19.23%), reinfection with a different strain occurred.
Conclusions Given the growing epidemic of DM worldwide, it is necessary to add DM prevention and control strategies to TB control programmes and vice versa and to evaluate their effectiveness. The concurrence of both diseases potentially carries a risk of global spreading, with serious implications for TB control and the achievement of the United Nations Millennium Development Goals.
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