Glycemic Control Effect on Acid-Fast Bacteria Conversion

A study conducted at Khon Kaen Hospital in Thailand analyzed data from the Tuberculosis Database spanning from January 2018 to January 2021, focusing on adult outpatients. The research included 669 patients divided into three groups based on their diabetes status: a non-diabetic group with 512 patients, a controlled diabetes group with 30 patients (HbA1c <7%), and an uncontrolled diabetes group with 127 patients (HbA1c ≥7%). Key demographics and health conditions varied significantly among these groups; notably, the non-diabetic group was significantly younger and less likely to have hypertension, while chronic kidney disease was most prevalent in the controlled diabetes group.[1]

In terms of treatment efficacy, the study found that sputum acid-fast bacilli (AFB) conversion rates were similar across groups, with 77.9% of non-diabetic patients and 77.7% of diabetic patients achieving conversion. The odds ratio for sputum AFB conversion between diabetic and non-diabetic groups showed no significant difference (OR: 0.987; 95% CI: 0.625–1.559; P=0.955). Furthermore, when looking at treatment outcomes, there was no significant variation in cure rates between the controlled and uncontrolled diabetic groups, nor in treatment duration or mortality rates, indicating that diabetes control might not markedly influence TB treatment outcomes.[1]

Additionally, the study highlighted some associations with treatment results. Female gender was found to be significantly linked with a higher rate of sputum AFB conversion at 2 months (OR: 2.285; 95% CI: 1.376–3.794; P=0.074). However, no significant associations were observed between HbA1c levels and key outcomes like sputum conversion, cure rate, treatment duration, or mortality. This suggests that while diabetes does not substantially alter TB treatment efficacy, other factors such as gender might play a role in treatment response.[1]

In another study, subjects with controlled Random Blood Glucose (RBG) and controlled HbA1C levels exhibited a higher percentage of negative sputum smear conversion. Notably, those with a 31-50% decrement in RBG achieved the highest rate of conversion at 42%, while subjects with more than a 50% RBG decrement had a lower conversion rate of 24%, suggesting that a moderate control of blood glucose might be more beneficial for sputum smear conversion compared to either uncontrolled or excessively controlled glucose levels.[2]

References:

1. Suwannacho, R., Anantachina, N. and Sornprom, C., 2024. Glycated hemoglobin level and sputum acid—fast bacilli conversion in pulmonary tuberculosis. The Clinical Academia, 48(3), pp.84-91.

2. Septa, D. and Surjadi, L.M., 2023. Glycemic Control Effect on Acid-Fast Bacteria Conversion in Diabetic Patients with Tuberculosis. Jurnal Biomedika dan Kesehatan, 6(1), pp.62-70.