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. 2025 Jun 25;12(7):ofaf344.
doi: 10.1093/ofid/ofaf344. eCollection 2025 Jul.

High Rates of Mortality During Drug-Resistant Tuberculosis Treatment Among Individuals With Diabetes Mellitus and Low Body Mass Index

Lara D Veeken  1 , Iceu D Kulsum  2 , Bony W Lestari  1   3   4 , Prayudi Santoso  2 , Nanny N M Soetedjo  2   4 , Raspati C Koesoemadinata  4 , Adriana V Miranda  4 , Wini Sukmawati  4 , Argita D Salindri  4   5 , Arto Y Soeroto  2   4 , Reinout van Crevel  1   6
Affiliations

High Rates of Mortality During Drug-Resistant Tuberculosis Treatment Among Individuals With Diabetes Mellitus and Low Body Mass Index

Lara D Veeken et al. Open Forum Infect Dis. .

Abstract

Background: Diabetes is a risk factor for mortality during rifampicin-resistant tuberculosis (RR-TB) treatment, but whether its impact differs by nutritional status is unknown. We estimated the effect of diabetes and its interaction with low body mass index (BMI) (ie, <18.5 kg/m2) on all-cause mortality during treatment of RR-TB.

Methods: We used medical record data of adults treated for RR-TB in Indonesia between March 2020 and May 2022. Diabetes was defined as glycated hemoglobin ≥6.5% or prior diabetes diagnosis by healthcare providers. Cox proportional hazards regression was used to estimate the hazard rates of mortality during treatment comparing those with and without diabetes. Multiplicative and additive interactions were evaluated to determine if the effect of diabetes on mortality during treatment was moderated by BMI status.

Results: Among 345 individuals (57% male, 1.7% with human immunodeficiency virus, 59% with BMI <18.5 kg/m2), 96 (28%) had diabetes and 62 (18%) died. Adjusting for confounders, the hazard rates of mortality during treatment were higher among those with diabetes (adjusted hazard rate ratio [aHR], 2.05 [95% CI, 1.17-3.58]) or those with BMI <18.5 kg/m2 (aHR, 2.33 [95% CI, 1.28-4.21]). No significant multiplicative nor additive interaction was detected, but the hazard rates of mortality were highest among those with diabetes and BMI <18.5 kg/m2 (aHR, 7.14 [95% CI, 2.71-18.82]) compared to those without diabetes and BMI ≥18.5 kg/m2.

Conclusions: Having diabetes doubled the risk of mortality during RR-TB treatment. Highest mortality rates were observed among individuals with combined diabetes and low BMI.

Keywords: diabetes; drug-resistant tuberculosis; low BMI; mortality; rifampicin-resistant tuberculosis.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts.

Figures

Figure 1.
Figure 1.
Survival of individuals with rifampicin-resistant tuberculosis by diabetes mellitus (DM) and body mass index status with log-rank P value.
Figure 2.
Figure 2.
Adjusted hazard rate ratio of all-cause mortality during rifampicin-resistant tuberculosis treatment with 95% confidence intervals for those with diabetes mellitus (DM) and body mass index (BMI) <18.5 kg/m2 compared to those without DM and BMI ≥18.5 kg/m2.
See this image and copyright information in PMC

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