Effects of diabetes mellitus on retreatment of TB in Bangladesh

Habib, M.A., Afrin, K., Efa, S.S., Hossain, M.D., Islam, M.R., Rahman, M.M., Islam, N., Afroz, F., Rahim, M.A. and Hossain, M.D., 2024. Effects of diabetes mellitus on retreatment of Tuberculosis: A multi-centered case-control study from Bangladesh. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 36, p.100450.

Recurrence of active TB after treatment can be due to either a relapse of infection with the same strain or reinfection with a new strain of Mycobacterium tuberculosis. Several factors can influence the likelihood of recurrent TB, including treatment adherence, the severity of the initial episode, the patient’s immune status, and the risk of reinfection. In low-incidence settings, most recurrent TB cases are expected to be due to reactivation.

See also: https://lintblab.weebly.com/ 

Retreatment TB patients are those undergoing treatment again due to relapse, treatment failure, or loss to follow-up. Retreatment patients have lower cure rates compared to new TB patients and experience more side effects from second-line TB drugs. Retreatment of TB was significantly associated with irregular use of TB medications (ρ = 0.007). However, no significant association was found between retreatment TB and the type of TB in the first episode or the duration of the first treatment. Retreatment was also significantly associated with the presence of diabetes mellitus (DM) (ρ = 0.018) and higher HbA1C levels (ρ = 0.034).

See also: TB burden in Taiwan

Conditional logistic regression analysis identified two independent risk factors for TB retreatment: the number of previous TB episodes and the presence of DM. Patients with more than one previous episode had a 3.088 times higher chance of needing retreatment compared to those with only one episode (ρ = 0.019). Diabetic patients had a 2.817 times higher chance of retreatment compared to non-diabetic patients (ρ = 0.012).

See also: TB and DM

Univariable logistic regression analysis also found that diabetic patients who failed to reach their target HbA1C levels had 2.5 times higher risk of retreatment than those who achieved their target (ρ = 0.028). There was no significant association between the level of education and TB retreatment, nor between marital status and retreatment cases. Patients with multiple previous TB episodes are more likely to be immunocompromised, making them more prone to repeated TB infections. 

See also: TB and hypertension

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