AN OBSERVATIONAL STUDY ON THE OUTCOME OF ANTITUBERCULAR AND ANTIDIABETIC THERAPY IN PATIENTS OF TUBERCULOSIS WITH DIABETES MELLITUS AS COMORBIDITY
DOI:
https://doi.org/10.22159/ajpcr.2024v17i7.50922Keywords:
Antitubercular therapy, Antidiabetic therapy, Tuberculosis, Diabetes mellitus, Glycemic controlAbstract
Objectives: Overall goal: To observe and compare the effect of antitubercular and antidiabetic therapy on patients of tuberculosis with diabetes mellitus as comorbidity. To study the effect of antidiabetic therapy on treatment outcome of tuberculosis. To study the effect of antitubercular drugs on glycemic control of patients of tuberculosis with diabetes mellitus
Methods: A total of 134 patients of tuberculosis with and without diabetes mellitus were approached for enrollment in this prospective observational cohort study as per NTEP guidelines. Effects of antitubercular therapy on antidiabetes drugs and vice versa during this study were observed and noted. A comparison of outcomes between two groups of patients of tuberculosis with diabetes and tuberculosis without diabetes was done according to outcome parameters.
Results: Mortality was found in patients on ATT+ADD nearly 11.94% (n=8) as compared to patients on ATT only 2.98% (n=2). Delayed sputum conversion with higher sputum positive rate (1+) among patients on ATT+ADD (23.89%) and mean HbA1c value at the end of the continuous phase (CP) was 6.7±1.07 among patients on ATT+ADD.
Conclusion: The patients on ATT+ADD have higher sputum positivity rates and poor treatment outcomes as compared to patients on ATT alone. Poor glycemic control in patients receiving ATT+ADD unfavorably leads to poor compliance with antitubercular therapy.
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References
Shewade HD, Jeyashree K, Mahajan P, Shah AN, Kirubakaran R, Rao R, et al. Effect of glycemic control and type of diabetes treatment on unsuccessful TB treatment outcomes among people with TB-diabetes: A systematic review. PLoS One. 2017;12(10):e0186697. doi: 10.1371/ journal.pone.0186697, PMID: 29059214
Balakrishnan S, Vijayan S, Nair S, Subramoniapillai J, Mrithyunjayan S, Wilson N, et al. High diabetes prevalence among tuberculosis cases in Kerala, India. PLoS One. 2012;7(10):e46502.
Alisjahbana B, Sahiratmadja E, Nelwan EJ, Purwa AM, Ahmad Y, Ottenhoff TH, et al. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin Infect Dis. 2007;45(4):428-35. doi: 10.1086/519841, PMID: 17638189
Niazi AK, Kalra S. Diabetes and tuberculosis: A review of the role of optimal glycemic control. J Diabetes Metab Disord. 2012;11:28.
Baker MA, Harries AD, Jeon CY, Hart JE, Kapur A, Lönnroth K, et al. The impact of diabetes on tuberculosis treatment outcomes: A systematic review. BMC Med. 2011;9(81):81. doi: 10.1186/1741- 7015-9-81, PMID: 21722362
Meregildo-Rodriguez ED, Asmat-Rubio MG, Zavaleta-Alaya P, Vásquez-Tirado GA. Effect of oral antidiabetic drugs on tuberculosis risk and treatment outcomes: Systematic review and meta-analysis. Trop Med Infect Dis. 2022;7(11):343. doi: 10.3390/tropicalmed7110343, PMID: 36355885
Yu X, Li L, Xia L, Feng X, Chen F, Cao S, et al. Impact of metformin on the risk and treatment outcomes of tuberculosis in diabetics: A systematic review. BMC Infect Dis. 2019;19(1):859. doi: 10.1186/ s12879-019-4548-4, PMID: 31623569
Pan SW, Yen YF, Kou YR, Chuang PH, Su VY, Feng JY, et al. The risk of TB in patients with type 2 diabetes initiating metformin vs sulfonylurea treatment. Chest. 2018;153(6):1347-57. doi: 10.1016/j. chest.2017.11.040, PMID: 29253553
Marupuru S, Senapati P, Pathadka S, Miraj SS, Unnikrishnan MK, Manu MK. Protective effect of metformin against tuberculosis infections in diabetic patients: An observational study of South Indian tertiary healthcare facility. Braz J Infect Dis. 2017;21(3):312-6. doi: 10.1016/j.bjid.2017.01.001, PMID: 28199824
John NN, George JM, Poornachary NM. Effect of anti-tubercular drugs and impact of glycemic status in patients with tuberculosis and concomitant diabetic-tuberculosis patients. Indian J Pharm Pract. 2017;10(2):125-8. doi: 10.5530/ijopp.10.2.25
Degner NR, Wang JY, Golub JE, Karakousis PC. Metformin use reverses the increased mortality associated with diabetes mellitus during tuberculosis treatment. Clin Infect Dis. 2018;66(2):198-205. doi: 10.1093/cid/cix819, PMID: 29325084
Kurbatova EV, Cegielski JP, Lienhardt C, Akksilp R, Bayona J, Becerra MC, et al. Sputum culture conversion as a prognostic marker for end-of-treatment outcome in patients with multidrug-resistant tuberculosis: A secondary analysis of data from two observational cohort studies. Lancet Respir Med. 2015;3(3):201-9. doi: 10.1016/ S2213-2600(15)00036-3, PMID: 25726085
Horne DJ, Royce SE, Gooze L, Narita M, Hopewell PC, Nahid P, et al. Sputum monitoring during tuberculosis treatment for predicting outcome: Systematic review and meta-analysis. Lancet Infect Dis. 2010;10(6):387-94. doi: 10.1016/S1473-3099(10)70071-2, PMID 20510279
Alisjahbana B, van Crevel R, Sahiratmadja E, den Heijer M, Maya A, Istriana E, et al. Diabetes mellitus is strongly associated with tuberculosis in Indonesia. Int J Tuberc Lung Dis. 2006;10(6):696-700.
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Copyright (c) 2024 Dr. Jeenal Mistry, Dr. Anita Sinha, Dr. B. Divakar, Dr. Nayan Gavli, Dr. Parul Vadgama
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