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

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.

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, India 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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