In Addis Ababa, Ethiopia, researchers conducted a study across 10 subcities to understand the link between diabetes and latent tuberculosis infection (LTBI) among household contacts (HHCs) of newly diagnosed active pulmonary TB cases. These HHCs were identified through public health surveillance and were included in the study if they had a valid IGRA result and an HbA1c measurement either at enrollment or within the preceding year. The study defined HHCs as those who had close living or working interactions with the TB index cases, specifying the duration and intensity of contact.[1]
The diagnosis of TB in index cases was confirmed using either a positive acid-fast bacilli (AFB) sputum smear or a positive nucleic acid amplification test (Xpert MTB/RIF). However, the study had stringent inclusion criteria, excluding individuals under 15 years old, those with low hemoglobin levels, active TB, a history of TB, pregnancy, or those on certain immunosuppressive therapies. Additionally, HHCs without HIV who had previously undergone TB preventive treatment were also excluded, ensuring a focused cohort for analysis.[1]
The study primarily looked at the diabetes status of HHCs, using HbA1c levels to classify participants into categories of euglycemia, prediabetes, or diabetes based on American Diabetes Association standards, with self-reported diabetes history also considered. The key outcome was LTBI, identified through the QuantiFERON-TB Gold Plus test among participants showing no signs of active TB. From an initial pool of 857 potential participants, 597 were included, revealing a demographic where the majority were female, with a median age in the late twenties, and a small but significant number were HIV positive. The results indicated a high LTBI prevalence, with over 70% of the HHCs infected, highlighting the critical role of close contact and diabetes in TB management in high-risk communities.[1]
Among the 597 household contacts (HHCs) participating in the study, 5.2%, or 31 individuals, were diagnosed with diabetes, while 15%, or 92 participants, were identified as having prediabetes. The median body mass index (BMI) was notably higher among those with prediabetes at 23.3 kg/m² and even higher among those with diabetes at 26.1 kg/m², compared to the 20.5 kg/m² seen in euglycemic participants.[1]
The research revealed that 71% of the participants had latent tuberculosis infection (LTBI). Participants with LTBI were generally older, with a median age of 30.2 years, as opposed to 24.7 years for those without LTBI. The prevalence of LTBI was significantly elevated among those with diabetes, reaching 86.7%, in stark contrast to the 69.4% observed in euglycemics, indicating a prevalence difference of 17.7%. No significant distinction in LTBI prevalence was found between prediabetics and euglycemics.[1]
However, the association between diabetes and LTBI was notably more pronounced in participants aged 40 years and older, where there was a prevalence difference of 16.7% and an adjusted odds ratio of 3.68 for those with diabetes. In contrast, this association was not significant for those under 40, with a smaller prevalence difference of 2.8% and an adjusted odds ratio of 1.15, suggesting that the influence of diabetes on LTBI might be age-dependent.[1]
A prospective cohort study was carried out in Addis Ababa, Ethiopia, spanning from August 2020 to November 2021, focusing on the impact of diabetes mellitus (DM) on tuberculosis (TB) treatment outcomes. At the outset, 8.9% of the 267 participants were identified with diabetes, while 10.5% had prediabetes. Over the course of TB treatment, two additional diabetes diagnoses were made, one of which had started with prediabetes. Follow-up assessments showed that those initially diagnosed with prediabetes who did not progress to diabetes were categorized as TB patients without diabetes during the treatment phase.[2]
The study found that 94.0% of participants successfully managed their TB treatment, with outcomes distributed between cure (35.2%) and treatment completion (58.8%). However, 16 individuals faced challenges, resulting in poor TB outcomes, including deaths, loss to follow-up, transfers out, and treatment failure. Among participants with diabetes, including those newly diagnosed during treatment, the rate of poor TB outcomes was significantly higher, with 26.9% experiencing adverse results. Notably, diabetes was a factor in several of these negative outcomes, including two deaths, three transfers out, one case of loss to follow-up, and the sole instance of treatment failure.[2]
The analysis revealed that diabetes dramatically increased the risk of poor TB outcomes, with an adjusted odds ratio of 14.8 for those with diabetes compared to those without. Other contributing factors to poor TB outcomes identified in the multivariable analysis included having smear-positive pulmonary TB, extrapulmonary TB, and a history of other non-communicable diseases. These findings underscore the complex interplay between diabetes and TB management, highlighting the need for tailored treatment approaches for patients with these comorbidities.[2]
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