· High Undiagnosed Diabetes Prevalence:
- Finding: Among surveyed individuals, 4.0% had undiagnosed diabetes, and 33.7% had prediabetes, highlighting a significant gap in awareness and early detection. See also: https://tbreadingnotes.blogspot.com/2024/07/modeling-social-environmental-and.html
- Plan: Implement widespread community-based screening campaigns with portable diagnostic tools to detect diabetes early, focusing on high-risk populations.
· 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:
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
TBC 031
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