Therapeutic Outcome of Pulmonary Tuberculosis in Type-2 Diabetes Patients

Muhammad Kashif Munir; Muhammad  Adnan; Iffat  Shabbir; Tayyaba  Rahat; Sana  Rehman

doi:10.29054/apmc/2018.120

Muhammad Kashif Munir Research Officer, Pakistan Health Research Council, TB Research Centre, KEMU, Lahore
Muhammad Adnan Pakistan Health Research Council, Research Centre, Fatima Jinnah Medical University, Lahore
Iffat Shabbir Pakistan Health Research Council, Research Centre, Fatima Jinnah Medical University, Lahore
Tayyaba Rahat Pakistan Health Research Council, Research Centre, Fatima Jinnah Medical University, Lahore
Sana Rehman Research Officer, Pakistan Health Research Council, TB Research Centre, KEMU, Lahore

DOI: https://doi.org/10.29054/apmc/2018.120

Keywords: Therapeutics outcome, MDR, TB with diabetes, glycemic control

Abstract

Objective: Tuberculosis is a major cause of morbidity and mortality and diabetes is a leading risk factor of tuberculosis. Co-existence of tuberculosis and diabetes may increase the disease severity and worsen the treatment outcome. Therefore, objective is to find the anti-tuberculosis treatment outcome among pulmonary tuberculosis patients with or without diabetes mellitus; and to see the drug resistance pattern among treatment failure cases in both groups. Methodology: The cross-sectional study was carried out at PHRC Research Center FJMU Lahore in collaboration with PHRC TB Research Centre KEMU Lahore during the year 2013-14. The data of 268 patients including 187 pulmonary tuberculosis patients without diabetes and 81 with diabetes was analyzed. Anti-tuberculosis treatment according to current guidelines of Directly Observed Therapy (DOT) was provided to all patients; and were assessed for improvement of AFB smear; AFB culture and Chest X-Ray before and after four months of starting ATT. Data were analyzed by using Statistical Package for Social Sciences version 20. Results: Mean age of non-diabetic TB patients was 36±16 years; and of diabetic TB patients was 50±12 years. Mean duration of diabetes was 6±4 years. Other characteristics included 57.8% males, 42.2% females, and 53.7% had history of contact. Cough, expectoration, fever and weight loss were commonly occurring symptoms. Infiltration (76.1%) was the commonest type of lesion followed by consolidation (14.6%) and cavitation (9.3%). Findings of AFB Smear conversion, AFB Culture, and Chest X-ray were improved with time in both groups; and rates of improvement were significantly higher among non-diabetic TB patients (p <0.05). The frequency of drug resistance was lower among non-diabetic TB patients (7.0% vs. 19.8%) but the difference was insignificant. The rates of drug resistance and MDR were considerably higher among patients with poor glycemic control (p 0.036). Conclusion: Therapeutic outcome of pulmonary tuberculosis was poor among diabetic TB patients as compare to non-diabetic TB patients. Therefore, along with anti-tuberculosis treatment, improvement of glycemic control must be considered among diabetic TB patients for better treatment outcome and reduced drug resistance rate.