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Meta-Analysis
. 2023 Nov 20;23(1):813.
doi: 10.1186/s12879-023-08765-0.

Diabetes mellitus affects the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis

Guisheng Xu  1   2 , Xiaojiang Hu  3 , Yanshu Lian  4 , Xiuting Li  3
Affiliations
Meta-Analysis

Diabetes mellitus affects the treatment outcomes of drug-resistant tuberculosis: a systematic review and meta-analysis

Guisheng Xu et al. BMC Infect Dis. .

Abstract

Background: Both tuberculosis (TB) and diabetes mellitus (DM) are major public health problems threatening global health. TB patients with DM have a higher bacterial burden and affect the absorption and metabolism for anti-TB drugs. Drug-resistant TB (DR-TB) with DM make control TB more difficult.

Methods: This study was completed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guideline. We searched PubMed, Excerpta Medica Database (EMBASE), Web of Science, ScienceDirect and Cochrance Library for literature published in English until July 2022. Papers were limited to those reporting the association between DM and treatment outcomes among DR-TB and multidrug-resistant TB (MDR-TB) patients. The strength of association was presented as odds ratios (ORs) and their 95% confidence intervals (CIs) using the fixed-effects or random-effects models. This study was registered with PROSPERO, number CRD: 42,022,350,214.

Results: A total of twenty-five studies involving 16,905 DR-TB participants were included in the meta-analysis, of which 10,124 (59.89%) participants were MDR-TB patients, and 1,952 (11.54%) had DM history. In DR-TB patients, the pooled OR was 1.56 (95% CI: 1.24-1.96) for unsuccessful outcomes, 0.64 (95% CI: 0.44-0.94) for cured treatment outcomes, 0.63 (95% CI: 0.46-0.86) for completed treatment outcomes, and 1.28 (95% CI: 1.03-1.58) for treatment failure. Among MDR-TB patients, the pooled OR was 1.57 (95% CI: 1.20-2.04) for unsuccessful treatment outcomes, 0.55 (95% CI: 0.35-0.87) for cured treatment outcomes, 0.66 (95% CI: 0.46-0.93) for treatment completed treatment outcomes and 1.37 (95% CI: 1.08-1.75) for treatment failure.

Conclusion: DM is a risk factor for adverse outcomes of DR-TB or MDR-TB patients. Controlling hyperglycemia may contribute to the favorite prognosis of TB. Our findings support the importance for diagnosing DM in DR-TB /MDR-TB, and it is needed to control glucose and therapeutic monitoring during the treatment of DR-TB /MDR-TB patients.

Keywords: Diabetes mellitus; Drug-resistant tuberculosis; Multidrug-resistant tuberculosis; Treatment outcomes.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the study selection
Fig. 2
Fig. 2
Forest plots for the association of diabetes mellitus with unsuccessful treatment outcomes for DR-TB (A) and MDR-TB (B)
Fig. 3
Fig. 3
Funnel plot of the studies based on the association between DM and unsuccessful treatment outcomes for DR-TB (A) and MDR-TB (B)
Fig. 4
Fig. 4
Forest plots for the association of diabetes mellitus with death treatment outcomes for DR-TB (A) and MDR-TB (B). # The number in this study was zero
Fig. 5
Fig. 5
Forest plots for the association of diabetes mellitus with cured treatment outcomes for DR-TB (A) and MDR-TB (B)
Fig. 6
Fig. 6
Forest plots for the association of diabetes mellitus with completed treatment outcomes for DR-TB(A) and MDR-TB(B). # The number in this study was zero
Fig. 7
Fig. 7
Forest plots for the association of diabetes mellitus with failed treatment outcomes for DR-TB (A) and MDR-TB (B)
See this image and copyright information in PMC

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