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Meta-Analysis
. 2024 Dec;56(1):2313683.
doi: 10.1080/07853890.2024.2313683. Epub 2024 Feb 12.

Tuberculosis (TB) treatment challenges in TB-diabetes comorbid patients: a systematic review and meta-analysis

Mahnoor Khattak  1 , Anees Ur Rehman  1 , Tuba Muqaddas  1 , Rabia Hussain  2 , Muhammad Fawad Rasool  1 , Zikria Saleem  1 , Mesfer Safar Almalki  3 , Samar Adel Alturkistani  3 , Shuruq Zuhair Firash  4 , Oseid Mohammed Alzahrani  3 , Ammar Abdulraheem Bahauddin  5 , Safa Almarzooky Abuhussain  4 , Muath Fahmi Najjar  6 , Hossameldeen Mahmoud Ali Elsabaa  6 , Abdul Haseeb  6
Affiliations
Meta-Analysis

Tuberculosis (TB) treatment challenges in TB-diabetes comorbid patients: a systematic review and meta-analysis

Mahnoor Khattak et al. Ann Med. 2024 Dec.

Abstract

Background: The Directly Observed Treatment-Short Course (DOTS) Programme was implemented by WHO and includes a combination of four anti-tuberculosis (TB) drugs (isoniazid, pyrazinamide, ethambutol and rifampicin) for a period of six months to eradicate the TB infection completely. Diabetes mellitus (DM) is recognized as one of a strong contributor of TB according to World Health Organization (WHO). The presence of diabetes mellitus type 2 (DM type 2) makes TB treatment complicated. Thus, the objective of the current meta-analysis was to identify and quantify the impact of type 2 DM on treatment outcomes of TB patients treated under the DOTS Programme.

Methods: This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Through a systematic review of relevant literature, we focused on studies investigating treatment outcomes including extended treatment duration and recurrence for individuals with both TB and DM undergoing DOTS therapy. The extracted information included study designs, sample sizes, patient characteristics and reported treatment results.

Results: In 44 studies from different parts of the world, the pooled HR for the impact of DM on extended treatment duration and reoccurrence were HR 0.72, 95% CI 0.56-0.83, p < .01 and HR 0.93, 95% CI 0.70-1.04, p = .08, respectively. The pooled HR for impact of DM on composite TB treatment outcomes was calculated as 0.76 (95% CI 0.60-0.87), p < .01 with an effect size of 41.18. The heterogeneity observed among the included studies was moderate (I2 = 55.79%).

Conclusions: A negative impact of DM was found on recurrence and extended treatment duration in TB patients treated with DOTS therapy. DM type 2 is responsible for the TB treatment prolongation and TB recurrence rates. By implementing effective management strategies and advancing research, the challenges can be mitigated, arising due to the complex interaction between DM and TB.

Keywords: Diabetes mellitus; comorbidity; disease progression; extended treatment duration; recurrence; tuberculosis.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
Study selection process in line with the PRISMA guidelines.
Figure 2.
Figure 2.
Forest plot for impact of DM on extended treatment duration in TB-DM comorbid patients.
Figure 3.
Figure 3.
Forest plot of sub-group analysis for extended treatment duration in TB-DM comorbid patients.
Figure 4.
Figure 4.
Forest plot for impact of DM on recurrence in TB-DM comorbid patients.
Figure 5.
Figure 5.
Forest plot of sub-group analysis for recurrence in TB-DM comorbid patients.
Figure 6.
Figure 6.
Forest plot for composite TB treatment outcomes in TB-DM comorbid patients.
See this image and copyright information in PMC

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