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Free Content Prevalence of dysglycemia and clinical presentation of pulmonary tuberculosis in Western India

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SETTING: Pune, India.

OBJECTIVES: To estimate the prevalence and risk factors of pre-diabetes mellitus (DM) and DM, and its associations with the clinical presentation of tuberculosis (TB).

DESIGN: Screening for DM was conducted among adults (age  18 years) with confirmed TB between December 2013 and January 2017. We used multinomial regression to evaluate the risk factors for pre-DM (glycated hemoglobin [HbA1c]  5.7–6.5% or fasting glucose 100–125 mg/dl) and DM (HbA1c  6.5% or fasting glucose  126 mg/dl or random blood glucose > 200 mg/dl or self-reported DM history/treatment) and the association of dysglycemia with the severity of TB disease.

RESULTS: Among 1793 participants screened, 890 (50%) had microbiologically confirmed TB. Of these, 33% had pre-DM and 18% had DM; 41% were newly diagnosed. The median HbA1c level among newly diagnosed DM was 7.0% vs. 10.3% among known DM (P < 0.001). DM (adjusted OR [aOR] 4.94, 95%CI 2.33–10.48) and each per cent increase in HbA1c (aOR 1.42, 95%CI 1.01–2.01) was associated with >1+ smear grade or 9 days to TB detection.

CONCLUSION: Over half of newly diagnosed TB patients had DM or pre-DM. DM and increasing dysglycemia was associated with higher bacterial burden at TB diagnosis, potentially indicating a higher risk of TB transmission to close contacts.
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Keywords: India; TB; clinical presentation; diabetes mellitus; pre-diabetes mellitus; risk factors

Document Type: Research Article

Affiliations: 1: Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 2: Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India, Byramjee-Jeejeebhoy Government Medical College, Pune 3: Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India 4: Dr D Y Patil Medical College, Pune, India 5: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 6: Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA 7: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA

Publication date: December 1, 2017

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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