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. 2012;7(10):e46502.
doi: 10.1371/journal.pone.0046502. Epub 2012 Oct 15.

High diabetes prevalence among tuberculosis cases in Kerala, India

Shibu Balakrishnan  1 , Shibu Vijayan, Sanjeev Nair, Jayasankar Subramoniapillai, Sunilkumar Mrithyunjayan, Nevin Wilson, Srinath Satyanarayana, Puneet K Dewan, Ajay M V Kumar, Durai Karthickeyan, Matthew Willis, Anthony D Harries, Sreenivas Achuthan Nair
Affiliations

High diabetes prevalence among tuberculosis cases in Kerala, India

Shibu Balakrishnan et al. PLoS One. 2012.

Abstract

Background: While diabetes mellitus (DM) is a known risk factor for tuberculosis, the prevalence among TB patients in India is unknown. Routine screening of TB patients for DM may be an opportunity for its early diagnosis and improved management and might improve TB treatment outcomes. We conducted a cross-sectional survey of TB patients registered from June-July 2011 in the state of Kerala, India, to determine the prevalence of DM.

Methodology/principal findings: A state-wide representative sample of TB patients in Kerala was interviewed and screened for DM using glycosylated hemoglobin (HbA1c); patients self-reporting a history of DM or those with HbA1c ≥6.5% were defined as diabetic. Among 552 TB patients screened, 243(44%) had DM - 128(23%) had previously known DM and 115(21%) were newly diagnosed - with higher prevalence among males and those aged >50 years. The number needed to screen(NNS) to find one newly diagnosed case of DM was just four. Of 128 TB patients with previously known DM, 107(84%) had HbA1c ≥7% indicating poor glycemic control.

Conclusions/significance: Nearly half of TB patients in Kerala have DM, and approximately half of these patients were newly-diagnosed during this survey. Routine screening of TB patients for DM using HbA1c yielded a large number of DM cases and offered earlier management opportunities which may improve TB and DM outcomes. However, the most cost-effective ways of DM screening need to be established by futher operational research.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Sampled TB units in Kerala to estimate the prevalence of Diabetes Mellitus among TB patients.
See this image and copyright information in PMC

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