Aspects of patients with pulmonary TB and dysglycemia [TB0128]

Diabetes mellitus (DM) increases the risk of developing active tuberculosis (TB) by 2–3 times and is associated with poorer TB treatment outcomes compared to non-DM TB patients. However, prospective studies on the role of dysglycemia (DM and pre-DM) in TB clinical presentation and treatment response, especially in high TB-burden countries, remain limited.

In a cohort of 140 patients diagnosed with pulmonary TB (PTB), the prevalence of dysglycemia at baseline (M0) was 61.4% (47.1% pre-DM, 14.3% DM). Among the 20 DM patients, 65.0% (13/20) had a prior diagnosis of type 2 DM. Patients with pre-DM and DM (PDMTB group) more frequently presented with cavitary disease on chest X-ray (CXR) (84.8%) compared to non-glycemic TB (NGTB, 63.0%) and DMTB (65.0%) groups. Bilateral lung lesions were more common in the DMTB group than in the NGTB group, with a higher mean number of lung thirds affected in the DMTB and PDMTB groups.

Compared to NGTB patients, those with dysglycemia exhibited a higher prevalence of cavities (80.2% vs. 63.0%) and bilateral lesions (67.4% vs. 46.0%) on CXR, as well as a greater median number of affected lung thirds (3 vs. 2). However, follow-up imaging (M2 and MEND) revealed no statistical differences in CXR findings among the groups. Sputum smear positivity was significantly higher in the PDMTB and DMTB groups (93.0%) than in the NGTB group (75.9%, p = 0.005), although Xpert MTB/RIF and M. tuberculosis culture results were similar across groups. Resistant M. tuberculosis strains were more prevalent in the NGTB (20.9%) and PDMTB (19.0%) groups compared to the DMTB group (10.0%).

Independent factors associated with dysglycemia among PTB patients included higher BMI, presence of cavities on CXR, and positive sputum smear microscopy.

Source: Bezerra, A.L., Moreira, A.D.S.R., Isidoro-Gonçalves, L., Lara, C.F.D.S., Amorim, G., Silva, E.C., Kritski, A.L. and Carvalho, A.C.C., 2022. Clinical, laboratory, and radiographic aspects of patients with pulmonary tuberculosis and dysglycemia and tuberculosis treatment outcomes. Jornal Brasileiro de Pneumologia, 48(06), p.e20210505.