Pulmonary Tuberculosis (PTB) Prevalence & Factors in Diabetic Patients with Poor Glycemic Control In Mwanza

Sr. Gotfrida Marandu; Gaston Ng'onyanyi; Paul Alikado Sabuni

doi:10.18535/ijsrm/v12i02.mp02

Abstract

Introduction: Tuberculosis (TB) remains a global health threat. Diabetes mellitus (DM) is a critical risk factor for TB, particularly in patients with poor glycemic control.

Objective: To investigate the prevalence and associated factors of newly diagnosed pulmonary tuberculosis (PTB) among poorly controlled diabetic patients in Mwanza, Tanzania.

Methods: A cross-sectional study was conducted in two hospitals, enrolling adult diabetic patients with poor glycemic control. Data were collected through questionnaires, physical examinations, laboratory tests (FBG/RBG, HbA1c, GeneXpert, chest X-ray), and BMI calculation. The primary outcome was newly diagnosed PTB. Statistical analysis was performed using STATA.

Results: Among 97 participants, 59.8% were male, 74.2% were under 60 years old (mean age 48 years), and 81% had HbA1c exceeding 7%. The prevalence of newly diagnosed PTB was 18.6%, of which 12.4% were GeneXpert-positive and 6.2% were clinically/radiologically diagnosed. Obesity was a significant risk factor for PTB (OR=4.4, p=0.006). Overweight and age under 60 also showed higher PTB risk.

Conclusion: Diabetics with poor glycemic control, obesity, overweight, age under 60, and abnormal chest X-rays are at high risk for PTB and require screening. Early detection and control are crucial for preventing TB spread in this vulnerable population.

Keywords

Uncontrolled DiabetesObesityoverweightTuberculosis (TB)Body Mass Index

References

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Boillat-Blanco, N., Bovet, P., Ramaiya, K. L., Mganga, M., Minja, L. T., Saleh, L., . . . Daubenberger, C. (2016). Association between tuberculosis, diabetes and 25 hydroxyvitamin D in Tanzania: a longitudinal case control study. BMC infectious diseases, 16(1), 1-9.Google Scholar ↗
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Huang, L.-K., Wang, H.-H., Lai, Y.-C., & Chang, S.-C. (2017). The impact of glycemic status on radiological manifestations of pulmonary tuberculosis in diabetic patients. Plos one, 12(6), e0179750.Google Scholar ↗
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Khalid, N., Ahmad, F., & Qureshi, F. M. (2021). Association amid the comorbidity of Diabetes Mellitus in patients of Active Tuberculosis in Pakistan: A matched case control study. Pakistan Journal of Medical Sciences, 37(3), 816.Google Scholar ↗
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Ugarte-Gil, C., Alisjahbana, B., Ronacher, K., Riza, A. L., Koesoemadinata, R. C., Malherbe, S. T., . . . Lopez, S. (2020). Diabetes mellitus among pulmonary tuberculosis patients from 4 tuberculosis-endemic countries: the TANDEM study. Clinical Infectious Diseases, 70(5), 780-788.Google Scholar ↗
Wang, Y., Dou, M., Kou, T., Liu, Y., Lv, W., Han, L., . . . Schouten, E. G. (2021). Risk of having pulmonary tuberculosis in type 2 diabetes: A hospital-based matched case-control study. Asia Pacific Journal of Clinical Nutrition, 30(2), 303-310.Google Scholar ↗
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[refR-2] Alexander, M., Gupta, A., & Mathad, J. (2019). Is there a connection between gestational diabetes mellitus, human immunodeficiency virus infection, and tuberculosis? The International Journal of Tuberculosis and Lung Disease, 23(1), 19-25.Google Scholar ↗

[refR-3] Anyanwu, M. O., Ajumobi, O. O., Afolabi, N. B., Usman, A., & Kehinde, A. (2022). Diabetes mellitus and its associated factors among patients with tuberculosis attending directly observed treatment centres in Oyo State, Nigeria: a cross-sectional evaluation. BMJ open, 12(4).Google Scholar ↗

[refR-4] Barber, T. M. (2020). COVID-19 and diabetes mellitus: implications for prognosis and clinical management. Expert Review of Endocrinology & Metabolism, 15(4), 227-236.Google Scholar ↗

[refR-5] Bart Jurriaan, t. H. (2015). Structural violence, Diabetes and Agrocolonialism. A case study of the United States, Mexico, India and the Pacific Islands.Google Scholar ↗

[refR-6] Bates, M., Marais, B. J., & Zumla, A. (2015). Tuberculosis comorbidity with communicable and noncommunicable diseases. Cold Spring Harbor perspectives in medicine, 5(11).Google Scholar ↗

[refR-7] Boillat-Blanco, N., Bovet, P., Ramaiya, K. L., Mganga, M., Minja, L. T., Saleh, L., . . . Daubenberger, C. (2016). Association between tuberculosis, diabetes and 25 hydroxyvitamin D in Tanzania: a longitudinal case control study. BMC infectious diseases, 16(1), 1-9.Google Scholar ↗

[refR-8] Gupta, S., Koirala, J., Khardori, R., & Khardori, N. (2007). Infections in diabetes mellitus and hyperglycemia. Infectious disease clinics of North America, 21(3), 617-638.Google Scholar ↗

[refR-9] Huang, L.-K., Wang, H.-H., Lai, Y.-C., & Chang, S.-C. (2017). The impact of glycemic status on radiological manifestations of pulmonary tuberculosis in diabetic patients. Plos one, 12(6), e0179750.Google Scholar ↗

[refR-10] Ji, Y., Cao, H., Liu, Q., Li, Z., Song, H., Xu, D., . . . Wang, J. (2020). Screening for pulmonary tuberculosis in high-risk groups of diabetic patients. International Journal of Infectious Diseases, 93, 84-89.Google Scholar ↗

[refR-11] Kapur, A., & Harries, A. D. (2013). The double burden of diabetes and tuberculosis–public health implications. Diabetes research and clinical practice, 101(1), 10-19.Google Scholar ↗

[refR-12] Khalid, N., Ahmad, F., & Qureshi, F. M. (2021). Association amid the comorbidity of Diabetes Mellitus in patients of Active Tuberculosis in Pakistan: A matched case control study. Pakistan Journal of Medical Sciences, 37(3), 816.Google Scholar ↗

[refR-13] Khattab, M., Khader, Y. S., Al-Khawaldeh, A., & Ajlouni, K. (2010). Factors associated with poor glycemic control among patients with type 2 diabetes. Journal of Diabetes and its Complications, 24(2), 84-89.Google Scholar ↗

[refR-14] McMurry, H. S., Mendenhall, E., Rajendrakumar, A., Nambiar, L., Satyanarayana, S., & Shivashankar, R. (2019). Coprevalence of type 2 diabetes mellitus and tuberculosis in low‐income and middle‐income countries: a systematic review. Diabetes/metabolism research and reviews, 35(1), e3066.Google Scholar ↗

[refR-15] Milo, R. B., & Connelly, C. D. (2019). Predictors of glycemic management among patients with type 2 diabetes. Journal of clinical nursing, 28(9-10), 1737-1744.Google Scholar ↗

[refR-16] Mtwangambate, G., Kalluvya, S., Kidenya, B., Kabangila, R., Downs, J., Smart, L., . . . Peck, R. (2014). ‘Cough‐triggered’tuberculosis screening among adults with diabetes in Tanzania. Diabetic medicine, 31(5), 600-605.Google Scholar ↗

[refR-17] Naqshbandi, M., Harris, S. B., Esler, J. G., & Antwi-Nsiah, F. (2008). Global complication rates of type 2 diabetes in Indigenous peoples: A comprehensive review. Diabetes research and clinical practice, 82(1), 1-17.Google Scholar ↗

[refR-18] Obels, I., Ninsiima, S., Critchley, J. A., & Huangfu, P. (2022). Tuberculosis risk among people with diabetes mellitus in Sub‐Saharan Africa: a systematic review. Tropical Medicine & International Health, 27(4), 369-386.Google Scholar ↗

[refR-19] Organization, W. H. (2019). WHO guidelines on tuberculosis infection prevention and control: 2019 update: World Health Organization.Google Scholar ↗

[refR-20] Otu, A., Hashmi, M., Mukhtar, A. M., Kwizera, A., Tiberi, S., Macrae, B., . . . Mer, M. (2018). The critically ill patient with tuberculosis in intensive care: Clinical presentations, management and infection control. Journal of critical care, 45, 184-196.Google Scholar ↗

[refR-21] Pal, R., Ansari, M. A., Hameed, S., & Fatima, Z. (2016). Diabetes mellitus as hub for tuberculosis infection: A snapshot. International journal of chronic diseases, 2016.Google Scholar ↗

[refR-22] Segura-Cerda, C. A., López-Romero, W., & Flores-Valdez, M. A. (2019). Changes in host response to mycobacterium tuberculosis infection associated with type 2 diabetes: beyond hyperglycemia. Frontiers in cellular and infection microbiology, 9, 342.Google Scholar ↗

[refR-23] Stegenga, M. E., van der Crabben, S. N., Blümer, R. M., Levi, M., Meijers, J. C., Serlie, M. J., . . . van der Poll, T. (2008). Hyperglycemia enhances coagulation and reduces neutrophil degranulation, whereas hyperinsulinemia inhibits fibrinolysis during human endotoxemia. Blood, The Journal of the American Society of Hematology, 112(1), 82-89.Google Scholar ↗

[refR-24] Ugarte-Gil, C., Alisjahbana, B., Ronacher, K., Riza, A. L., Koesoemadinata, R. C., Malherbe, S. T., . . . Lopez, S. (2020). Diabetes mellitus among pulmonary tuberculosis patients from 4 tuberculosis-endemic countries: the TANDEM study. Clinical Infectious Diseases, 70(5), 780-788.Google Scholar ↗

[refR-25] Wang, Y., Dou, M., Kou, T., Liu, Y., Lv, W., Han, L., . . . Schouten, E. G. (2021). Risk of having pulmonary tuberculosis in type 2 diabetes: A hospital-based matched case-control study. Asia Pacific Journal of Clinical Nutrition, 30(2), 303-310.Google Scholar ↗

[refR-26] Wu, Z., Guo, J., Huang, Y., Cai, E., Zhang, X., Pan, Q., & Shen, X. (2016). Diabetes mellitus in patients with pulmonary tuberculosis in an aging population in Shanghai, China: Prevalence, clinical characteristics and outcomes. Journal of Diabetes and its Complications, 30(2), 237-241.Google Scholar ↗

[refR-27] Yu, Y., Kong, Y., Ye, J., & Wang, A. (2020). Performance of conventional histopathology and GeneXpert MTB/RIF in the diagnosis of spinal tuberculosis from bone specimens: a prospective clinical study. Clinical Biochemistry, 85, 33-37.Google Scholar ↗