Sunday, January 12, 2025

How Diabetes Fuels Tuberculosis in Vulnerable Communities

· High Undiagnosed Diabetes Prevalence:

· Diabetes as a Risk Factor for Tuberculosis (TB):

  • Finding: TB prevalence increased with diabetes severity, affecting 7.6% of diabetics compared to 4.1% of non-diabetics. Diabetes increased TB risk by 1.5 times. See also: https://lintblab.weebly.com/speeches-and-courses.html
  • Plan: Integrate TB screening into diabetes clinics to identify co-infections early and promote collaboration between TB and diabetes management programs.

· TB Infection Linked to Socioeconomic Factors:

  • Finding: TB infection rates were higher among individuals with lower education (11.3%) and larger households (10.4%), indicating socioeconomic disparities.
  • Plan: Enhance TB education programs in low-income communities and provide targeted interventions, including improved ventilation in crowded living spaces.

· Severe Diabetes Increases TB Risk:

  • Finding: Indicators such as insulin use, chronic kidney disease, and long-term diabetes significantly raised TB risk.
  • Plan: Prioritize TB screening for patients with severe diabetes indicators during routine clinical visits to reduce undetected cases.

· Blood Glucose Levels and TB Risk Relationship:

  • Finding: Fasting blood glucose levels below 100 mg/dL increased TB risk by 37%, likely due to malnutrition or liver dysfunction.
  • Plan: Educate patients on balanced nutrition and ensure regular monitoring of glucose levels, particularly in high-risk populations.

· Latent TB Infection (LTBI) in High-Risk Groups:

  • Finding: LTBI prevalence was 71% among household contacts of TB cases, with diabetics showing the highest rates (86.7%).
  • Plan: Establish LTBI screening protocols for close contacts of TB patients, especially those with diabetes, and provide preventive therapy as appropriate.

· Poor TB Outcomes Among Diabetics:

  • Finding: Diabetic TB patients had a 15-fold increased risk of poor outcomes, including death and treatment failure.
  • Plan: Develop personalized treatment plans for diabetic TB patients and enhance follow-up care to reduce adverse outcomes.

· Impact of Diabetes on Drug-Resistant TB:

  • Finding: Diabetics with drug-resistant TB (DR-TB) or multidrug-resistant TB (MDR-TB) were 1.56 to 1.57 times more likely to experience treatment failure.
  • Plan: Introduce routine drug-susceptibility testing for diabetics with TB to ensure appropriate and effective treatment regimens.

· Geospatial Data Enhances TB Control:

  • Finding: Spatial analysis improves understanding of TB transmission patterns and enables targeted interventions in high-risk areas.
  • Plan: Integrate geospatial tools into TB surveillance systems to identify hotspots and deploy resources effectively in resource-constrained settings.

References:

  1. Martinez, L., Zhu, L., Castellanos, M.E., Liu, Q., Chen, C., Hallowell, B.D. and Whalen, C.C., 2017. Glycemic control and the prevalence of tuberculosis infection: a population-based observational study. Clinical Infectious Diseases, 65(12), pp.2060-2068.
  2. Kang, J.Y., Han, K., Lee, S.H. and Kim, M.K., 2023. Diabetes severity is strongly associated with the risk of active tuberculosis in people with type 2 diabetes: a nationwide cohort study with a 6-year follow-up. Respiratory Research, 24(1), pp.1-9.
  3. Smith, A. G. C., Kempker, R. R., Wassie, L., Bobosha, K., Nizam, A., Gandhi, N. R., Auld, S. C., Magee, M. J., Blumberg, H. M., & Tuberculosis Research Unit: Role of Antigen Specific Responses in the Control of TB (TBRU-ASTRa) Study Group. (2022). The impact of diabetes and prediabetes on prevalence of Mycobacterium tuberculosis infection among household contacts of active tuberculosis cases in Ethiopia. Open Forum Infectious Diseases, 9(7), ofac323.
  4. Adane, H.T., Howe, R.C., Wassie, L. and Magee, M.J., 2023. Diabetes mellitus is associated with an increased risk of unsuccessful treatment outcomes among drug-susceptible tuberculosis patients in Ethiopia: A prospective health facility-based study. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 31, p.100368.
  5. Lin, H., Shin, S., Blaya, J.A., Zhang, Z., Cegielski, P., Contreras, C., Asencios, L., Bonilla, C., Bayona, J., Paciorek, C.J. and Cohen, T., 2011. Assessing spatiotemporal patterns of multidrug-resistant and drug-sensitive tuberculosis in a South American setting. Epidemiology & Infection, 139(11), pp.1784-1793.
  6. Lin HH, Shin SS, Contreras C, Asencios L, Paciorek CJ, Cohen T. Use of spatial information to predict multidrug resistance in tuberculosis patients, Peru. Emerg Infect Dis. 2012 May;18(5):811-3. doi: 10.3201/eid1805.111467.
  7. Xu, G., Hu, X., Lian, Y. and Li, X., 2023. Diabetes mellitus affects the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis. BMC Infectious Diseases, 23(1), p.813.
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