Diabetes Mellitus and Tuberculosis Treatment Outcomes in Pune, India

Overview

Journal Open Forum Infect Dis

Specialty Infectious Diseases

Date 2021 Apr 22

PMID 33884278

Citations 16

Authors

Vidya Mave

Sanjay Gaikwad

Madhusudan Barthwal

Ajay Chandanwale

Rahul Lokhande

Dileep Kadam

Sujata Dharmshale

Renu Bharadwaj

Anju Kagal

Neeta Pradhan

Sona Deshmukh

Sachin Atre

Tushar Sahasrabudhe

Shailesh Meshram

Arjun Kakrani

Vandana Kulkarni

Swapnil Raskar

Nishi Suryavanshi

Hardy Kornfeld

Kelly E Dooley

Sandy Chon

Akshay Gupte

Amita Gupta

Nikhil Gupte

Jonathan E Golub

Affiliations

Soon will be listed here.

Abstract

Background: Diabetes mellitus (DM) increases the risk of tuberculosis (TB) disease. Knowledge of the impact of DM on TB treatment outcomes is primarily based on retrospective studies.

Methods: We conducted a prospective cohort study of new pulmonary TB patients with and without DM (TB-DM and TB only) in India. The association of DM with a composite unfavorable TB treatment outcome (failure, recurrence, mortality) over 18 months was determined, and the effect of DM on all-cause mortality and early mortality (death during TB treatment) was assessed.

Results: Of 799 participants, 574 (72%) had TB only and 225 (28%) had TB-DM. The proportion of patients with DM who experienced the composite outcome was 20%, as compared with 21% for TB-only participants (adjusted hazard ratio [aHR], 1.13; 95% CI, 0.75-1.70). Mortality was higher in participants with DM (10% vs 7%), and early mortality was substantially higher among patients with DM (aHR, 4.36; 95% CI, 1.62-11.76).

Conclusions: DM was associated with early mortality in this prospective cohort study, but overall unfavorable outcomes were similar to participants without DM. Interventions to reduce mortality during TB treatment among people with TB-DM are needed.

Citing Articles

Clinical and Mycobacterium tuberculosis strain characteristics of tuberculosis patients with diabetes mellitus in Changping District, Beijing, China.

Cao X, Song Z, He P, Li X, Lei N, Sun Q BMC Infect Dis. 2025; 25(1):101.

PMID: 39844060 PMC: 11753084. DOI: 10.1186/s12879-025-10470-z.

Tuberculosis treatment outcomes and associated factors: A retrospective study in West Nusa Tenggara, Indonesia.

Meiyanti M, Bachtiar A, Kusumaratna R, Alfiyyah A, Machrumnizar M, Pusparini P Narra J. 2025; 4(3):e1660.

PMID: 39816109 PMC: 11731667. DOI: 10.52225/narra.v4i3.1660.

Prevalence trends, population characteristics and treatment outcomes of tuberculosis combined with diabetes in Southwest China: a register-based retrospective study.

Kong D, Xia Y, Wang X, Zhang Y, Zhong J, Zhang T Front Public Health. 2024; 12:1445857.

PMID: 39635223 PMC: 11616032. DOI: 10.3389/fpubh.2024.1445857.

The Complex Relationship Between Tuberculosis and Hyperglycemia.

Byers M, Guy E Diagnostics (Basel). 2024; 14(22).

PMID: 39594205 PMC: 11593071. DOI: 10.3390/diagnostics14222539.

Pathogenesis of Post-Tuberculosis Lung Disease: Defining Knowledge Gaps and Research Priorities at the Second International Post-Tuberculosis Symposium.

Auld S, Barczak A, Bishai W, Coussens A, Dewi I, Mitini-Nkhoma S Am J Respir Crit Care Med. 2024; 210(8):979-993.

PMID: 39141569 PMC: 11531093. DOI: 10.1164/rccm.202402-0374SO.

References

Harries A, Kumar A, Satyanarayana S, Lin Y, Zachariah R, Lonnroth K . Diabetes mellitus and tuberculosis: programmatic management issues. Int J Tuberc Lung Dis. 2015; 19(8):879-86. PMC: 4497633. DOI: 10.5588/ijtld.15.0069. View

Vashisht R, Brahmachari S . Metformin as a potential combination therapy with existing front-line antibiotics for Tuberculosis. J Transl Med. 2015; 13:83. PMC: 4359515. DOI: 10.1186/s12967-015-0443-y. View

Harries A, Kumar A, Satyanarayana S, Lin Y, Zachariah R, Lonnroth K . Addressing diabetes mellitus as part of the strategy for ending TB. Trans R Soc Trop Med Hyg. 2016; 110(3):173-9. PMC: 4755424. DOI: 10.1093/trstmh/trv111. View

Kornfeld H, West K, Kane K, Kumpatla S, Zacharias R, Martinez-Balzano C . High Prevalence and Heterogeneity of Diabetes in Patients With TB in South India: A Report from the Effects of Diabetes on Tuberculosis Severity (EDOTS) Study. Chest. 2016; 149(6):1501-8. PMC: 4944775. DOI: 10.1016/j.chest.2016.02.675. View

Dooley K, Tang T, Golub J, Dorman S, Cronin W . Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. Am J Trop Med Hyg. 2009; 80(4):634-9. PMC: 2750857. View

Martinez N, Kornfeld H . Diabetes and immunity to tuberculosis. Eur J Immunol. 2014; 44(3):617-26. PMC: 4213860. DOI: 10.1002/eji.201344301. View

Huangfu P, Pearson F, Ugarte-Gil C, Critchley J . Diabetes and poor tuberculosis treatment outcomes: issues and implications in data interpretation and analysis. Int J Tuberc Lung Dis. 2018; 21(12):1214-1219. DOI: 10.5588/ijtld.17.0211. View

Kornfeld H, Sahukar S, Procter-Gray E, Kumar N, West K, Kane K . Impact of Diabetes and Low Body Mass Index on Tuberculosis Treatment Outcomes. Clin Infect Dis. 2020; 71(9):e392-e398. PMC: 7713690. DOI: 10.1093/cid/ciaa054. View

Singhal A, Jie L, Kumar P, Hong G, Leow M, Paleja B . Metformin as adjunct antituberculosis therapy. Sci Transl Med. 2014; 6(263):263ra159. DOI: 10.1126/scitranslmed.3009885. View

10.

Wallis R, Maeurer M, Mwaba P, Chakaya J, Rustomjee R, Migliori G . Tuberculosis--advances in development of new drugs, treatment regimens, host-directed therapies, and biomarkers. Lancet Infect Dis. 2016; 16(4):e34-46. DOI: 10.1016/S1473-3099(16)00070-0. View

11.

Bhargava A, Chatterjee M, Jain Y, Chatterjee B, Kataria A, Bhargava M . Nutritional status of adult patients with pulmonary tuberculosis in rural central India and its association with mortality. PLoS One. 2013; 8(10):e77979. PMC: 3812022. DOI: 10.1371/journal.pone.0077979. View

12.

Odone A, Houben R, White R, Lonnroth K . The effect of diabetes and undernutrition trends on reaching 2035 global tuberculosis targets. Lancet Diabetes Endocrinol. 2014; 2(9):754-64. DOI: 10.1016/S2213-8587(14)70164-0. View

13.

Critchley J, Restrepo B, Ronacher K, Kapur A, Bremer A, Schlesinger L . Defining a Research Agenda to Address the Converging Epidemics of Tuberculosis and Diabetes: Part 1: Epidemiology and Clinical Management. Chest. 2017; 152(1):165-173. PMC: 5989639. DOI: 10.1016/j.chest.2017.04.155. View

14.

Mave V, Nimkar S, Prasad H, Kadam D, Meshram S, Lokhande R . Tuberculosis screening among persons with diabetes mellitus in Pune, India. BMC Infect Dis. 2017; 17(1):388. PMC: 5457599. DOI: 10.1186/s12879-017-2483-9. View

15.

Baker M, Harries A, Jeon C, Hart J, Kapur A, Lonnroth K . The impact of diabetes on tuberculosis treatment outcomes: a systematic review. BMC Med. 2011; 9:81. PMC: 3155828. DOI: 10.1186/1741-7015-9-81. View

16.

Ma Y, Pang Y, Shu W, Liu Y, Ge Q, Du J . Metformin reduces the relapse rate of tuberculosis patients with diabetes mellitus: experiences from 3-year follow-up. Eur J Clin Microbiol Infect Dis. 2018; 37(7):1259-1263. DOI: 10.1007/s10096-018-3242-6. View

17.

Rehm J, Samokhvalov A, Neuman M, Room R, Parry C, Lonnroth K . The association between alcohol use, alcohol use disorders and tuberculosis (TB). A systematic review. BMC Public Health. 2009; 9:450. PMC: 2796667. DOI: 10.1186/1471-2458-9-450. View

18.

Marupuru S, Senapati P, Pathadka S, Miraj S, Unnikrishnan M, Manu M . Protective effect of metformin against tuberculosis infections in diabetic patients: an observational study of south Indian tertiary healthcare facility. Braz J Infect Dis. 2017; 21(3):312-316. PMC: 9427654. DOI: 10.1016/j.bjid.2017.01.001. View

19.

Kapur A, Harries A, Lonnroth K, Wilson P, Sulistyowati L . Diabetes and tuberculosis co-epidemic: the Bali Declaration. Lancet Diabetes Endocrinol. 2015; 4(1):8-10. DOI: 10.1016/S2213-8587(15)00461-1. View

20.

Degner N, Wang J, Golub J, Karakousis P . Metformin Use Reverses the Increased Mortality Associated With Diabetes Mellitus During Tuberculosis Treatment. Clin Infect Dis. 2018; 66(2):198-205. PMC: 5848303. DOI: 10.1093/cid/cix819. View