Diabetes mellitus may lead to adverse outcomes in multidrug-resistant tuberculosis (MDR-TB) or DR-TB, according to systematic review and meta-analysis findings published in BMC Infectious Diseases.
Patients with TB and comorbid diabetes have a higher bacterial burden that affects the absorption of TB control agents. Investigators therefore sought to evaluate the association between diabetes mellitus (DM) and DR-/MDR-TB treatment outcomes.
The investigators conducted a systematic review and meta-analysis, searching the Cochrane Library, ScienceDirect, Web of Science, EMBASE, and PubMed databases through June 2022 for studies in English reporting the associations between DM and DR-TB and MDR-TB treatment outcomes. Overall, 25 studies (N=16,905 participants with DR-TB) were included for analysis (9 cohort, 14 case-control, and 2 cross-sectional studies only). Among these participants, 60.0% (10,124) had MDR-TB, 11.5% (1952) with a history of DM. Globally, DM in patients with TB is 15.4%.
Overall, 14 studies had moderate risk of bias and 11 studies had low risk of bias; 20 studies included Asian populations, 4 studies included European populations, 3 included African populations, and 1 included American populations.
The investigators found the pooled odds ratio (OR) among all patients with DR-TB for cured outcomes was 0.64 (95% CI, 0.44-0.94); the OR for unsuccessful outcomes was 1.56 (95% CI, 1.24-1.96); the OR for treatment completed outcomes was 0.63 (95% CI, 0.46-0.86); and the OR for treatment failure was 1.28 (95% CI, 1.03-1.58).
“Cured” was defined as treatment completed without evidence of failure, with at least 3 consecutive negative cultures at least 30 days apart following the intensive phase. “Treatment completed” was defined as treatment completed without evidence of failure but no record of at least 3 consecutive negative cultures at least 30 days apart following the intensive phase. “Unsuccessful” treatment was defined the treatment of all individuals not classified as cured or with treatment completed. “Failure” was defined as treatment terminated or the need for permanent regimen change of at least 2 anti-TB drugs.
The pooled OR among all patients with MDR-TB for cured outcomes was 0.55 (95% CI, 0.35-0.87); the OR for unsuccessful outcomes was 1.57 (95% CI, 1.20-2.04); the OR for treatment completed outcomes was 0.66 (95% CI, 0.46-0.93); the OR for treatment failure was 1.37 (95% CI, 1.08-1.75).
Moderate to substantial heterogeneity was found in cured and unsuccessful outcomes in pooled effects ORs.
The pooled OR for risk of death among patients with DR-/MDR-TB was 1.32 (95% CI, 0.97-1.82) for those with DM and 1.33 for those without DM (95% CI, 0.85-2.07). Significant heterogeneity was noted in DR-TB and MDR-TB studies.
Systematic review and meta-analysis limitations include the lack of randomized controlled trials.
“DM is a risk factor for adverse outcomes in DR-TB or MDR-TB patients,” the investigators concluded, who added that controlling hyperglycemia may contribute to a more favorable TB prognosis. “Our findings support the importance for diagnosing DM in DR-TB /MDR-TB, and [the need] to control glucose and therapeutic monitoring during the treatment of DR-TB /MDR-TB patients,” the researchers added.
References:
Xu G, Hu X, Lian Y, Li X. Diabetes mellitus affects the treatment outcomes of drug-resistant tuberculosis: A systematic review and meta-analysis. BMC Infect Dis. Published online November 20, 2023. doi:10.1186/s12879-023-08765-0
Source: Pulmonology Advisor