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. 2021 Mar 4;8(4):ofab097.
doi: 10.1093/ofid/ofab097. eCollection 2021 Apr.

Diabetes Mellitus and Tuberculosis Treatment Outcomes in Pune, India

Vidya Mave  1   2 , Sanjay Gaikwad  1   3 , Madhusudan Barthwal  4 , Ajay Chandanwale  1   3 , Rahul Lokhande  1   3 , Dileep Kadam  1   3 , Sujata Dharmshale  1   3 , Renu Bharadwaj  1   3 , Anju Kagal  1   3 , Neeta Pradhan  1 , Sona Deshmukh  1 , Sachin Atre  4 , Tushar Sahasrabudhe  4 , Shailesh Meshram  4 , Arjun Kakrani  4 , Vandana Kulkarni  1 , Swapnil Raskar  1 , Nishi Suryavanshi  1 , Hardy Kornfeld  5 , Kelly E Dooley  2 , Sandy Chon  2 , Akshay Gupte  6 , Amita Gupta  1   2   6 , Nikhil Gupte  1   2 , Jonathan E Golub  2   6
Affiliations

Diabetes Mellitus and Tuberculosis Treatment Outcomes in Pune, India

Vidya Mave et al. Open Forum Infect Dis. .

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.

Keywords: India; diabetes mellitus; mortality; tuberculosis; unfavorable treatment outcomes.

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Figures

Figure 1.
Figure 1.
Study flowchart illustrating flow of study participants from screening to enrollment into the prospective tuberculosis cohort by diabetes mellitus status.
Figure 2.
Figure 2.
A, Kaplan-Meier curve showing time to early mortality (death during the period of tuberculosis treatment) among patients with tuberculosis (TB) by diabetes mellitus (DM) status. The red line represents patients with DM, and the blue line represents patients without DM. B, Kaplan-Meier curve showing time to early mortality by newly diagnosed diabetes mellitus (DM) and known DM among patients with tuberculosis (TB). The blue line represents patients with TB without DM, the green line represents newly diagnosed DM, and the red line represents known DM.
See this image and copyright information in PMC

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