The Influence of Diabetes, Glycemic Control, and Diabetes-Related Comorbidities on Pulmonary Tuberculosis

To assess the influence of diabetes mellitus (DM), glycemic control, and diabetes-related comorbidities on manifestations and outcome of treatment of pulmonary tuberculosis (TB). Culture positive pulmonary TB patients notified to health authorities in three hospitals in Taiwan from 2005-2010 were in...

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Vydané v:PLOS ONE Ročník 10; číslo 3; s. e0121698
Hlavní autori: Chiang, Chen Yuan, Bai, Kuan Jen, Lin, Hsien Ho, Chien, Shun Tien, Lee, Jen Jyh, Enarson, Donald A., Lee, Ting-I, Yu, Ming-Chih
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Public Library of Science (PLoS) 30.03.2015
Public Library of Science
Predmet:
Adult
Aged
Analysis
Antibiotics
Antitubercular Agents
Antitubercular Agents - therapeutic use
Comorbidity
Cough
Diabetes
Diabetes Complications
Diabetes Complications - blood
Diabetes Complications - epidemiology
Diabetes Complications - therapy
Diabetes Mellitus
Diabetes Mellitus - blood
Diabetes Mellitus - epidemiology
Diabetes Mellitus - therapy
Diabetics
Drug resistance
Epidemiology
Fatalities
Female
Glucose
Glycated Hemoglobin
Glycated Hemoglobin A - metabolism
Health aspects
Health risks
Hemoglobin
Hemoglobins
Hemoptysis
Hospitals
Humans
Hyperglycemia
Internal medicine
Isoniazid
Lung diseases
Male
Medicine
Middle Aged
Multivariate Analysis
Patients
Preventive medicine
Pulmonary tuberculosis
Q
R
Research Article
Rifampin
Science
Smear
Smoking
Taiwan
Taiwan - epidemiology
Treatment Outcome
Tuberculosis
Tuberculosis, Pulmonary
Tuberculosis, Pulmonary - complications
Tuberculosis, Pulmonary - drug therapy
Tuberculosis, Pulmonary - epidemiology
France
Taiwan
ISSN:1932-6203, 1932-6203
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Shrnutí:To assess the influence of diabetes mellitus (DM), glycemic control, and diabetes-related comorbidities on manifestations and outcome of treatment of pulmonary tuberculosis (TB). Culture positive pulmonary TB patients notified to health authorities in three hospitals in Taiwan from 2005-2010 were investigated. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C) and diabetic patients were categorized into 3 groups: HbA1C<7%, HbA1C 7-9%, HbA1C>9%. 1,473 (705 with DM and 768 without DM) patients were enrolled. Of the 705 diabetic patients, 82 (11.6%) had pretreatment HbA1C<7%, 152 (21.6%) 7%-9%, 276 (39.2%) >9%, and 195 (27.7%) had no information of HbA1C. The proportions of patients with any symptom, cough, hemoptysis, tiredness and weight loss were all highest in diabetic patients with HbA1C>9%. In multivariate analysis adjusted for age, sex, smoking, and drug resistance, diabetic patients with HbA1C>9% (adjOR 3.55, 95% CI 2.40-5.25) and HbA1C 7-9% (adjOR 1.62, 95% CI 1.07-2.44) were significantly more likely to be smear positive as compared with non-diabetic patients, but not those with HbA1C<7% (adjOR 1.16, 95% CI 0.70-1.92). The influence of DM on outcome of TB treatment was not proportionately related to HbA1C, but mainly mediated through diabetes-related comorbidities. Patients with diabetes-related comorbidities had an increased risk of unfavorable outcome (adjOR 3.38, 95% CI 2.19-5.22, p<0.001) and one year mortality (adjOR 2.80, 95% CI 1.89-4.16). However, diabetes was not associated with amplification of resistance to isoniazid (p = 0.363) or to rifampicin (p = 0.344). Poor glycemic control is associated with poor TB treatment outcome and improved glycemic control may reduce the influence of diabetes on TB.
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Conceived and designed the experiments: CYC KJB HHL STC JJL DAE TIL MCY. Performed the experiments: CYC KJB STC JJL. Analyzed the data: CYC. Wrote the paper: CYC. Contributed to the revision of the manuscript and gave approval to the final version of the manuscript: CYC KJB HHL STC JJL DAE TIL MCY.
Competing Interests: The authors have declared that no competing interests exist.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0121698