Clinical characteristics, drug resistance, and treatment outcomes among tuberculosis patients with diabetes in Peru

• Type of Material: Article
• Authors: Matthew Magee, Emory University; E Bloss, US Centers for Disease Control and Prevention; SS Shin, Partners in Health; C Contreras, Socios En Salud, Peru; H Arbanil Huaman, Ministerio de Salud del Perú; J Calderon Ticona, Ministerio de Salud del Perú; J Bayona, Partners in Health, Boston; C Bonilla, Ministerio de Salud del Perú; M Yagui, Instituto Nacional de Salud, Lima, Peru; O Jave, Ministerio de Salud del Perú; J. Cegielski, Emory University
• Language: English
• Date: 2013-06-01
• Publisher: ELSEVIER SCI LTD
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2013 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.ijid.2012.12.029
• Title of Journal or Parent Work: INTERNATIONAL JOURNAL OF INFECTIOUS DISEASES
• Volume: 17
• Issue: 6
• Start Page: E404
• End Page: E412
• Grant/Funding Information: This work was supported by the US Centers for Disease Control and Prevention (US CDC), NIAID K23 AI054591-01A2, the Bill & Melinda Gates Foundation, Heiser Foundation, and the Infectious Diseases Society of America. Some of the authors of this publication are employed by the US CDC.
• Keywords: Tuberculosis; PULMONARY TUBERCULOSIS; MANIFESTATIONS; IMPACT; Infectious Diseases; Life Sciences & Biomedicine; Diabetes; Peru; RISK; Science & Technology; Multi-drug resistance; MELLITUS

Abstract

Objectives: Diabetes is a risk factor for active tuberculosis (TB). Data are limited regarding the association between diabetes and TB drug resistance and treatment outcomes. We examined characteristics of TB patients with and without diabetes in a Peruvian cohort at high risk for drug-resistant TB. Among TB patients with diabetes (TB-DM), we studied the association between diabetes clinical/management characteristics and TB drug resistance and treatment outcomes. Methods: During 2005-2008, adults with suspected TB with respiratory symptoms in Lima, Peru, who received rapid drug susceptibility testing (DST), were prospectively enrolled and followed during treatment. Bivariate and Kaplan-Meier analyses were used to examine the relationships of diabetes characteristics with drug-resistant TB and TB outcomes. Results: Of 1671 adult TB patients enrolled, 186 (11.1%) had diabetes. TB-DM patients were significantly more likely than TB patients without diabetes to be older, have had no previous TB treatment, and to have a body mass index (BMI) >18.5kg/m2 (p<0.05). In patients without and with previous TB treatment, the prevalence of multidrug-resistant TB was 23% and 26%, respectively, among patients without diabetes, and 12% and 28%, respectively, among TB-DM patients. Among 149 TB-DM patients with DST results, 104 (69.8%) had drug-susceptible TB and 45 (30.2%) had drug-resistant TB, of whom 29 had multidrug-resistant TB. There was no association between diabetes characteristics and drug-resistant TB. Of 136 TB-DM patients with outcome information, 107 (78.7%) had a favorable TB outcome; active diabetes management was associated with a favorable outcome. Conclusions: Diabetes was common in a cohort of TB patients at high risk for drug-resistant TB. Despite prevalent multidrug-resistant TB among TB-DM patients, the majority had a favorable TB treatment outcome. © 2013 International Society for Infectious Diseases.