Early interventions for diabetes related tuberculosis associate with hastened sputum microbiological clearance in Virginia, USA.
BACKGROUND
Diabetes complicates tuberculosis (TB) treatment including a prolonged time of sputum culture conversion to negative growth. Since 2013 in Virginia, interventions early in the treatment course have used therapeutic drug monitoring and dose correction for isoniazid and rifampin after 2 weeks of TB treatment in patients with diabetes along with nurse manager initiated diabetes education and linkage to care.


METHODS
A retrospective cohort study of the state TB registry was performed for patients initiating drug-susceptible pulmonary TB treatment that were matched for age, gender, chest imaging and sputum smear status to compare time to sputum culture conversion and other clinical outcomes in the pre-and post-intervention groups.


RESULTS
Three hundred sixty-three patients had documented time to sputum culture conversion in the pre-and post-intervention periods, including 56 (15%) with diabetes. Seventy-four (57%) of all patients with diabetes were ≥60 years of age at treatment initiation. Twenty-six patients with diabetes were matched in each group. Mean time to sputum culture conversion in the post-intervention group was 42 ± 22 days compared to the pre-intervention group of 62 ± 31 days (p = 0.01). In the post-intervention group 21 (80%) of patients with diabetes had culture conversion by 2 months compared to 13 (50%) in the pre-intervention group (p = 0.04).


CONCLUSIONS
Early interventions for diabetes related TB in the programmatic setting may hasten sputum culture conversion.
['Alkabab|Yosra|Y|0000-0002-7743-9172', 'Keller|Suzanne|S|', 'Dodge|Denise|D|', 'Houpt|Eric|E|', 'Staley|Deborah|D|', 'Heysell|Scott|S|']
D000328:Adult D000368:Aged D000995:Antitubercular Agents D048909:Diabetes Complications D016903:Drug Monitoring D018479:Early Intervention, Educational D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009169:Mycobacterium tuberculosis D012189:Retrospective Studies D013183:Sputum D014376:Tuberculosis D014768:Virginia
Early intervention Diabetes Tuberculosis Sputum culture conversion Therapeutic drug monitoring Clinical outcomes