The Effect of Diabetes Mellitus on the Treatment Outcome of Tuberculosis

Abstract

Introduction: Tuberculosis and diabetes mellitus both are the two most important public health problems in
India. India is presently having the highest burden of tuberculosis and second highest burden of diabetes mellitus
globally. Many studies have shown to have poorer treatment outcome of tuberculosis in diabetic patients.
Aim: To evaluate the difference in treatment outcome antitubercular regimens in diabetic patients compared to
non-diabetic patients.
Materials and Methods: Active tuberculosis patients presenting to Department of Respiratory Medicine of
IPGME&R, Kolkata were taken and divided into two groups- with and without diabetes mellitus (according to
ADA criteria). Two groups were matched for age, sex, addiction habits, history of contact with tuberculosis and
previous treatment for tuberculosis. Treatment for tuberculosis and diabetes mellitus have been given to both
the groups according to standard protocol and they are followed up for glycemic control, treatment outcome for
tuberculosis (according to standard outcome parameters and clinicoradiological outcome) including adverse drug
reaction, need for hospitalization and mortality. Statistical analysis was also done to evaluate accuracy of HbA1c at
the end of treatment to predict the clinicoradiological outcome.
Results: In this outcome analysis, patients with tuberculosis and diabetes have poorer clinicoradiological outcome
(36%) and unsuccessful treatment outcome (10%), higher rate of hospitalisation(OR=8.5) and mortality (4%). ROCcurve analysis showed a cut-off HbA1c<7.4 to have a good clinicoradiological outcome at end of treatment.
Conclusion: Diabetes has negative effect on outcome of anti-tubercular treatment as poor glycemic control during
the course of treatment often lead to poor outcome of tuberculosis. So every tuberculosis patient should be screened
for diabetes mellitus at the onset of treatment and proper anti-diabetic therapy is to be given along with standard
anti-tubercular treatment for favourable outcome.