While diabetes mellitus (DM) is a known risk factor for tuberculosis,
the prevalence among TB patients in India is unknown. Routine screening
of TB patients for DM may be an opportunity for its early diagnosis and
improved management and might improve TB treatment outcomes. The authors
conducted a cross-sectional survey of TB patients registered from
June–July 2011 in the state of Kerala, India, to determine the
prevalence of DM.
A state-wide representative sample of TB patients in Kerala was
interviewed and screened for DM using glycosylated hemoglobin (HbA1c);
patients self-reporting a history of DM or those with HbA1c ≥6.5% were
defined as diabetic. Among 552 TB patients screened, 243(44%) had DM
-128(23%) had previously known DM and 115(21%) were newly diagnosed -
with higher prevalence among males and those aged >50years. The
number needed to screen(NNS) to find one newly diagnosed case of DM was
just four. Of 128 TB patients with previously known DM, 107(84%) had
HbA1c ≥7% indicating poor glycemic control.
Nearly half of TB patients in Kerala have DM, and approximately half of
these patients were newly-diagnosed during this survey. Routine
screening of TB patients for DM using HbA1c yielded a large number of DM
cases and offered earlier management opportunities which may improve TB
and DM outcomes. However, the most cost-effective ways of DM screening
need to be established by futher operational research.
Balakrishnan, S.; Vijayan, S.; Nair, S.; Subramoniapillai, J.; Mrithyunjayan, S.; Wilson, N.; Satyanarayana, S.; Dewan, PK.; Kumar, AMV.; Karthickeyan, D.; Willis, M.; Harries, AD.; Nair, SA. High Diabetes Prevalence among Tuberculosis Cases in Kerala, India. PLoS ONE (2012) 7 (10) e46502. [DOI: 10.1371/journal.pone.0046502]
High Diabetes Prevalence among Tuberculosis Cases in Kerala, India.