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The effect of diabetes control status on treatment response in pulmonary tuberculosis: a prospective study
  1. Young Soon Yoon1,
  2. Jae-Woo Jung2,
  3. Eun Ju Jeon3,
  4. Haesook Seo4,
  5. Yon Ju Ryu5,
  6. Jae-Joon Yim6,
  7. Yee Hyung Kim7,
  8. Byoung-Hoon Lee8,
  9. Yong Bum Park9,
  10. Byoung Jun Lee10,
  11. Hyun Kang11,
  12. Jae Chol Choi2
  1. 1Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, South Korea
  2. 2Division of Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University, School of Medicine, Seoul, South Korea
  3. 3Department of Internal Medicine, Hallym Hospital, Incheon, South Korea
  4. 4Department of Tuberculosis, Seobuk Hospital, Seoul Metropolitan Government, Seoul, South Korea
  5. 5Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University, School of Medicine, Seoul, South Korea
  6. 6Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
  7. 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
  8. 8Department of Pulmonology and Allergy, Eulji Hospital, College of Medicine, Eulji University, Seoul, South Korea
  9. 9Department of Internal Medicine, Hallym University Medical Center, Kangdong Sacred Heart Hospital, Seoul, South Korea
  10. 10Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, South Korea
  11. 11Department of Anesthesiology and Pain Medicine, Chung-Ang University, School of Medicine, Seoul, South Korea
  1. Correspondence to Dr Jae Chol Choi, Division of Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University Hospital, HeukSeok Ro 102, Dong Jak Gu, Seoul 06973, Republic of Korea; medics27{at}cau.ac.kr

Abstract

Background Uncontrolled diabetes, unlike controlled diabetes, is associated with an impaired immune response. However, little is known about the impact of the status of diabetes control on clinical features and treatment outcomes in patients with pulmonary TB (PTB). We conducted this study to evaluate whether the status of diabetes control influences clinical manifestations and treatment responses in PTB.

Methods A multicentre prospective study was performed between September 2012 and September 2014. The patients were categorised into three groups according to the glycated haemoglobin (HbA1C) level: PTB without diabetes mellitus (non-DM), PTB with controlled diabetes (controlled-DM) and PTB with uncontrolled diabetes (uncontrolled-DM). The primary outcome was the sputum culture conversion rate after 2 months of intensive treatment.

Results Among 661 patients with PTB, 157 (23.8%) had diabetes and 108 (68.8%) had uncontrolled diabetes (HbA1C≥7.0%). The uncontrolled-DM group exhibited more symptoms, positive sputum smears (p<0.001) and presence of cavities (p<0.001) than the non-DM group. Regarding treatment responses, patients with uncontrolled-DM were more likely to have a positive culture after 2 months (p=0.009) and either treatment failure (p=0.015) or death (p=0.027) compared with the non-DM group. In contrast, those with controlled-DM showed similar treatment responses to the non-DM group. In multivariable analysis, uncontrolled diabetes was an independent risk factor for a positive sputum culture after 2 months of treatment (adjusted OR, 2.11; p=0.042) and either treatment failure or death (adjusted OR, 4.11; p=0.022).

Conclusions Uncontrolled diabetes is an independent risk factor for poor treatment response in PTB.

  • Tuberculosis

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