The effect of diabetes control status on treatment response in pulmonary tuberculosis: a prospective study.
BACKGROUND
Uncontrolled diabetes, unlike controlled diabetes, is associated with an impaired immune response. However, little is known about the impact of the status of diabetes control on clinical features and treatment outcomes in patients with pulmonary TB (PTB). We conducted this study to evaluate whether the status of diabetes control influences clinical manifestations and treatment responses in PTB.


METHODS
A multicentre prospective study was performed between September 2012 and September 2014. The patients were categorised into three groups according to the glycated haemoglobin (HbA1C) level: PTB without diabetes mellitus (non-DM), PTB with controlled diabetes (controlled-DM) and PTB with uncontrolled diabetes (uncontrolled-DM). The primary outcome was the sputum culture conversion rate after 2 months of intensive treatment.


RESULTS
Among 661 patients with PTB, 157 (23.8%) had diabetes and 108 (68.8%) had uncontrolled diabetes (HbA1C≥7.0%). The uncontrolled-DM group exhibited more symptoms, positive sputum smears (p<0.001) and presence of cavities (p<0.001) than the non-DM group. Regarding treatment responses, patients with uncontrolled-DM were more likely to have a positive culture after 2 months (p=0.009) and either treatment failure (p=0.015) or death (p=0.027) compared with the non-DM group. In contrast, those with controlled-DM showed similar treatment responses to the non-DM group. In multivariable analysis, uncontrolled diabetes was an independent risk factor for a positive sputum culture after 2 months of treatment (adjusted OR, 2.11; p=0.042) and either treatment failure or death (adjusted OR, 4.11; p=0.022).


CONCLUSIONS
Uncontrolled diabetes is an independent risk factor for poor treatment response in PTB.
['Yoon|Young Soon|YS|', 'Jung|Jae-Woo|JW|', 'Jeon|Eun Ju|EJ|', 'Seo|Haesook|H|', 'Ryu|Yon Ju|YJ|', 'Yim|Jae-Joon|JJ|', 'Kim|Yee Hyung|YH|', 'Lee|Byoung-Hoon|BH|', 'Park|Yong Bum|YB|', 'Lee|Byoung Jun|BJ|', 'Kang|Hyun|H|', 'Choi|Jae Chol|JC|']
D000293:Adolescent D000328:Adult D000368:Aged D000995:Antitubercular Agents D003920:Diabetes Mellitus D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D011379:Prognosis D011446:Prospective Studies D056910:Republic of Korea D012307:Risk Factors D016896:Treatment Outcome D014397:Tuberculosis, Pulmonary
Tuberculosis