PREVALENCE OF TYPE-2 DIABETES MELLITUS AMONG PATIENTS WITH PULMONARY TUBERCULOSIS: A HOSPITAL BASED CROSS SECTIONAL STUDY
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Keywords
Tuberculosis, Type-2 Diabetes Mellitus, Cross-sectional Study, Prevalence, India, Comorbidity
Abstract
Introduction: Tuberculosis (TB) remains a major public health challenge in India, which also faces a rapidly rising burden of Type-2 Diabetes Mellitus (T2DM). Diabetes not only increases the risk of developing TB but may also worsen its clinical course and treatment outcomes. Understanding the magnitude of diabetes among pulmonary TB patients is essential for integrated disease control. The present study was conducted to determine the prevalence of T2DM among microbiologically confirmed pulmonary TB patients and to assess its association with demographic, lifestyle, and clinical factors.
Materials and Methods: This hospital-based cross-sectional study was conducted at a tertiary care hospital for a period of 6 months. A total of 60 consecutive adult patients (≥18 years) with newly diagnosed, microbiologically confirmed pulmonary TB (sputum smear microscopy, CBNAAT/GeneXpert, or culture positive) were recruited.. After obtaining informed consent, data were collected using a pre-tested proforma, including socio-demographics, lifestyle habits, and clinical history. All patients were screened for diabetes using American Diabetes Association (ADA 2023) criteria. Data were entered into MS Excel and analyzed using SPSS version 20.
Results: The prevalence of T2DM among pulmonary TB patients was 23.3% (14/60), of which 35.7% were newly detected. Diabetes was significantly associated with older age (>40 years, p=0.02) and higher BMI (≥25 kg/m², p=0.04). Male patients had slightly higher prevalence than females, but the difference was not significant. Diabetic TB patients showed trends toward higher sputum positivity (85.7% vs. 69.6%) and more cavitary lesions on chest X-ray (57.1% vs. 34.8%), although not statistically significant.
Conclusion: Nearly one in four pulmonary TB patients had co-existing T2DM, with a substantial proportion being newly diagnosed. Diabetes was associated with older age and obesity, and appeared to worsen TB severity. These findings highlight the need for routine bidirectional screening and integrated management of TB and diabetes in clinical practice.
References
2. Ministry of Health and Family Welfare, Government of India. India TB Report 2023. New Delhi: Central TB Division; 2023.
3. International Diabetes Federation. IDF Diabetes Atlas, 10th edition. Brussels, Belgium: IDF; 2021.
4. Anjana RM, Deepa M, Pradeepa R, et al. Prevalence of diabetes and prediabetes in 15 states of India: results from the ICMR-INDIAB population-based cross-sectional study. Lancet Diabetes Endocrinol. 2017;5(8):585–596.
5. Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med. 2008;5(7):e152.
6. Restrepo BI. Diabetes and tuberculosis. Microbiol Spectr. 2016;4(6).
7. Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis. 2009;9(12):737–746.
8. Baker MA, Harries AD, Jeon CY, et al. The impact of diabetes on tuberculosis treatment outcomes: a systematic review. BMC Med. 2011;9:81.
9. Stevenson CR, Forouhi NG, Roglic G, et al. Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence. BMC Public Health. 2007;7:234.
10. Kumar Nathella P, Babu S. Influence of diabetes mellitus on immunity to human tuberculosis. Immunology. 2017;152(1):13–24.
11. Viswanathan V, Kumpatla S, Aravindalochanan V, et al. Prevalence of diabetes and pre-diabetes among tuberculosis patients in India. PLoS One. 2012;7(7):e41367.
12. Balakrishnan S, Vijayan S, Nair S, et al. High diabetes prevalence among tuberculosis cases in Kerala, India. PLoS One. 2012;7(10):e46502.
13. World Health Organization and The International Union Against Tuberculosis and Lung Disease. Collaborative framework for care and control of tuberculosis and diabetes. Geneva: WHO; 2011.
14. Central TB Division. National Strategic Plan for Tuberculosis Elimination 2017–2025. Ministry of Health and Family Welfare, Government of India; 2017.
15. American Diabetes Association. Classification and diagnosis of diabetes: Standards of Medical Care in Diabetes—2023. Diabetes Care. 2023;46(Suppl 1):S19-S40.
16. Viswanathan V, Kumpatla S, Aravindalochanan V, et al. Prevalence of diabetes and pre-diabetes and associated risk factors among tuberculosis patients in India. PLoS One. 2012;7(7):e41367.
17. Balakrishnan S, Vijayan S, Nair S, et al. High diabetes prevalence among tuberculosis cases in Kerala, India. PLoS One. 2012;7(10):e46502.
18. India TB-Diabetes Study Group. Screening of patients with tuberculosis for diabetes mellitus in India. Trop Med Int Health. 2013;18(5):636–645.
19. Ruslami R, Aarnoutse RE, Alisjahbana B, van der Ven AJ, van Crevel R. Implications of the global increase of diabetes for tuberculosis control and patient care. Trop Med Int Health. 2010;15(11):1289–1299.
20. Restrepo BI, Camerlin AJ, Rahbar MH, et al. Cross-sectional assessment reveals high diabetes prevalence among newly-diagnosed tuberculosis cases. Bull World Health Organ. 2011;89(5):352–359.
21.Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med. 2008;5(7):e152.
22. Chen L, Wang J, Chen Y, et al. Mycobacterium tuberculosis infection among diabetes patients in China. Trop Med Int Health. 2015;20(5):659–666.
23. Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis. 2009;9(12):737–746.
24. Baker MA, Harries AD, Jeon CY, et al. The impact of diabetes on tuberculosis treatment outcomes: a systematic review. BMC Med. 2011;9:81.
25. World Health Organization & The Union. Collaborative framework for care and control of tuberculosis and diabetes. Geneva: WHO; 2011.
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Dr. M. S. GURURAJ
Associate Professor, Department of Community Medicine, Viswabharathi Medical College, Kurnool, Andhra Pradesh
Dr. P. SATYA REDDY
Assistant Professor, Department of Community Medicine, Viswabharathi Medical College, Kurnool, Andhra Pradesh
Dr. P. RAMAKRISHNA MURTHY
Assistant Professor, Department of Community Medicine, Viswabharathi Medical College, Kurnool, Andhra Pradesh
Dr. P. RAMU
Assistant Professor, Department of Community Medicine, Viswabharathi Medical College, Kurnool, Andhra Pradesh