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Diabetes characteristics and long-term management needs in diabetic TB patients

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BACKGROUND: Diabetes mellitus (DM) is common among patients with TB. We assessed DM characteristics and long-term needs of DM-TB patients after completing TB treatment.

METHODS: Newly diagnosed TB patients with DM were recruited for screening in a randomised clinical trial evaluating a simple algorithm to improve glycaemic control during TB treatment. DM characteristics, lifestyle and medication were compared before and after TB treatment and 6 months later. Risk of cardiovascular disease (CVD), albuminuria and neuropathy were assessed after TB treatment.

RESULTS: Of 218 TB-DM patients identified, 170 (78%) were followed up. Half were males, the mean age was 53 years, 26.5% were newly diagnosed DM. High glycated haemoglobin at TB diagnosis (median 11.2%) decreased during TB treatment (to 7.4% with intensified management and 8.4% with standard care), but this effect was lost 6 months later (9.3%). Hypertension and dyslipidemia contributed to a high 10-year CVD risk (32.9% at month 6 and 35.5% at month 12). Neuropathy (33.8%) and albuminuria (61.3%) were common. After TB treatment, few patients used CVD-mitigating drugs.

CONCLUSION: DM in TB-DM patients is characterised by poor glycaemic control, high CVD risk, and nephropathy. TB treatment provides opportunities for better DM management, but effort is needed to improve long-term care.

Keywords: cardiovascular risk; glycaemic control; nephropathy; urban setting

Document Type: Research Article

Affiliations: 1: Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands 2: Centre for International Health, Division of Health Sciences, University of Otago Medical School, Dunedin, New Zealand 3: Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Internal Medicine, Faculty of Medicine, Universitas Padjadjaran/ Dr Hasan Sadikin General Hospital, Bandung, Indonesia 4: Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia 5: Research Center for Care and Control of Infectious Disease, Universitas Padjadjaran, Bandung, Indonesia, Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia 6: Population Health Research Institute, St George´s University of London, London, UK 7: Faculty of Infectious and Tropical Diseases and Tuberculosis Centre, London School of Hygiene & Tropical Medicine, London, UK 8: Department of Internal Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands, Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK

Publication date: February 1, 2023

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