High Diabetes Prevalence among Tuberculosis Cases in Kerala, India

While diabetes mellitus (DM) is a known risk factor for tuberculosis, the prevalence among TB patients in India is unknown. Routine screening of TB patients for DM may be an opportunity for its early diagnosis and improved management and might improve TB treatment outcomes. We conducted a cross-sect...

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Published in:PloS one Vol. 7; no. 10; p. e46502
Main Authors: Balakrishnan, Shibu, Vijayan, Shibu, Nair, Sanjeev, Subramoniapillai, Jayasankar, Mrithyunjayan, Sunilkumar, Wilson, Nevin, Satyanarayana, Srinath, Dewan, Puneet K., Kumar, Ajay M. V., Karthickeyan, Durai, Willis, Matthew, Harries, Anthony D., Nair, Sreenivas Achuthan
Format: Journal Article
Language:English
Published: United States Public Library of Science 15.10.2012
Public Library of Science (PLoS)
Subjects:
Care and treatment
Causes of
Clinical outcomes
Diabetes
Diabetes mellitus
Diabetes Mellitus - epidemiology
Diagnosis
Female
Five year plans
Glucose
Glycated Hemoglobin A - analysis
Glycosylated hemoglobin
Health risks
Health services
Hemoglobin
Humans
India - epidemiology
Lung diseases
Male
Males
Medical diagnosis
Medicine
Microscopy
Middle Aged
Operations research
Patient outcomes
Patients
Prevalence
Prevention
Risk factors
Screening
Surveys
Systematic review
Tuberculosis
Tuberculosis - complications
Tuberculosis - epidemiology
India
Kerala India
ISSN:1932-6203, 1932-6203
Online Access:Get full text
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Summary:While diabetes mellitus (DM) is a known risk factor for tuberculosis, the prevalence among TB patients in India is unknown. Routine screening of TB patients for DM may be an opportunity for its early diagnosis and improved management and might improve TB treatment outcomes. We conducted a cross-sectional survey of TB patients registered from June-July 2011 in the state of Kerala, India, to determine the prevalence of DM. A state-wide representative sample of TB patients in Kerala was interviewed and screened for DM using glycosylated hemoglobin (HbA1c); patients self-reporting a history of DM or those with HbA1c ≥6.5% were defined as diabetic. Among 552 TB patients screened, 243(44%) had DM - 128(23%) had previously known DM and 115(21%) were newly diagnosed - with higher prevalence among males and those aged >50 years. The number needed to screen(NNS) to find one newly diagnosed case of DM was just four. Of 128 TB patients with previously known DM, 107(84%) had HbA1c ≥7% indicating poor glycemic control. Nearly half of TB patients in Kerala have DM, and approximately half of these patients were newly-diagnosed during this survey. Routine screening of TB patients for DM using HbA1c yielded a large number of DM cases and offered earlier management opportunities which may improve TB and DM outcomes. However, the most cost-effective ways of DM screening need to be established by futher operational research.
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Conceived and designed the experiments: SB SV SN JS SM NW SS PKD AMVK MW ADH SAN. Performed the experiments: SB SV SN JS SM DSAK. Analyzed the data: SB SV SN SS AMVK. Contributed reagents/materials/analysis tools: SB SV SN JS SM SS AMVK. Wrote the paper: SB SV SN. Provided comments and inputs to revise manuscript: JS SM NW SS PKD AMVK MW ADH SAN.
Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0046502