Diabetes is a strong predictor of mortality during tuberculosis treatment: a prospective cohort study among tuberculosis patients from Mwanza, Tanzania

Daniel Faurholt-Jepsen; Nyagosya Range; George PrayGod; Kidola Jeremiah; Maria Faurholt-Jepsen; Martine Aabye; John Changalucha; Dirk Lund Christensen; Harleen M S Grewal; Torben Martinussen; Henrik Krarup; Daniel R Witte; Aase B Andersen; Henrik Friis

doi:10.1111/tmi.12120

Diabetes is a strong predictor of mortality during tuberculosis treatment: a prospective cohort study among tuberculosis patients from Mwanza, Tanzania

Daniel Faurholt-Jepsen, Nyagosya Range, George PrayGod, Kidola Jeremiah, Maria Faurholt-Jepsen, Martine Aabye, John Changalucha, Dirk Lund Christensen, Harleen M S Grewal, Torben Martinussen, Henrik Krarup, Daniel R Witte, Aase B Andersen, Henrik Friis

65 Citationer (Scopus)

Abstract

Objective: Strong evidence suggests diabetes may be associated with tuberculosis (TB) and could influence TB treatment outcomes. We assessed the role of diabetes on sputum culture conversion and mortality among patients undergoing TB treatment. Methods: A total of 1250 Tanzanian TB patients were followed prospectively during TB treatment with sputum culture after 2 and 5 months. Survival status was assessed at least 1 year after initiation of treatment. At baseline, all participants underwent testing for diabetes and HIV, and the serum concentration of the acute phase reactant alpha-1 glycoprotein (AGP) was determined. Results: There were no differences between participants with and without diabetes regarding the proportion of positive cultures at 2 (3.8% vs. 5.8%) and 5 (1.3% vs. 0.9%) months (P > 0.46). However, among patients with a positive TB culture, relatively more patients with diabetes died before the 5-month follow-up. Within the initial 100 days of TB treatment, diabetes was associated with a fivefold increased risk of mortality (RR 5.09, 95% CI 2.36; 11.02, P < 0.001) among HIV uninfected, and a twofold increase among HIV co-infected patient (RR 2.33 95% CI 1.20; 4.53, P = 0.012), while diabetes was not associated with long-term mortality. Further adjustment with AGP did not change the estimates. Conclusion: Diabetes considerably increases risk of early mortality during TB treatment. The effect may not be explained by increased severity of TB, but could be due to impaired TB treatment response. Research is needed to clarify the mechanism and to assess whether glycaemic control improves survival.

Originalsprog	Engelsk
Tidsskrift	Tropical Medicine & International Health
Vol/bind	18
Udgave nummer	7
Sider (fra-til)	822-829
Antal sider	8
ISSN	1360-2276
DOI	https://doi.org/10.1111/tmi.12120
Status	Udgivet - jul. 2013

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10.1111/tmi.12120

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Faurholt-Jepsen, D., Range, N., PrayGod, G., Jeremiah, K., Faurholt-Jepsen, M., Aabye, M., Changalucha, J., Christensen, D. L., Grewal, H. M. S., Martinussen, T., Krarup, H., Witte, D. R., Andersen, A. B., & Friis, H. (2013). Diabetes is a strong predictor of mortality during tuberculosis treatment: a prospective cohort study among tuberculosis patients from Mwanza, Tanzania. Tropical Medicine & International Health, 18(7), 822-829. https://doi.org/10.1111/tmi.12120

Diabetes is a strong predictor of mortality during tuberculosis treatment : a prospective cohort study among tuberculosis patients from Mwanza, Tanzania. / Faurholt-Jepsen, Daniel; Range, Nyagosya; PrayGod, George et al.

I: Tropical Medicine & International Health, Bind 18, Nr. 7, 07.2013, s. 822-829.

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

Faurholt-Jepsen, D, Range, N, PrayGod, G, Jeremiah, K, Faurholt-Jepsen, M, Aabye, M, Changalucha, J, Christensen, DL, Grewal, HMS, Martinussen, T, Krarup, H, Witte, DR, Andersen, AB & Friis, H 2013, 'Diabetes is a strong predictor of mortality during tuberculosis treatment: a prospective cohort study among tuberculosis patients from Mwanza, Tanzania', Tropical Medicine & International Health, bind 18, nr. 7, s. 822-829. https://doi.org/10.1111/tmi.12120

@article{4501ec881218496e963e0407a5c036e0,

title = "Diabetes is a strong predictor of mortality during tuberculosis treatment: a prospective cohort study among tuberculosis patients from Mwanza, Tanzania",

abstract = "Objective: Strong evidence suggests diabetes may be associated with tuberculosis (TB) and could influence TB treatment outcomes. We assessed the role of diabetes on sputum culture conversion and mortality among patients undergoing TB treatment. Methods: A total of 1250 Tanzanian TB patients were followed prospectively during TB treatment with sputum culture after 2 and 5 months. Survival status was assessed at least 1 year after initiation of treatment. At baseline, all participants underwent testing for diabetes and HIV, and the serum concentration of the acute phase reactant alpha-1 glycoprotein (AGP) was determined. Results: There were no differences between participants with and without diabetes regarding the proportion of positive cultures at 2 (3.8% vs. 5.8%) and 5 (1.3% vs. 0.9%) months (P > 0.46). However, among patients with a positive TB culture, relatively more patients with diabetes died before the 5-month follow-up. Within the initial 100 days of TB treatment, diabetes was associated with a fivefold increased risk of mortality (RR 5.09, 95% CI 2.36; 11.02, P < 0.001) among HIV uninfected, and a twofold increase among HIV co-infected patient (RR 2.33 95% CI 1.20; 4.53, P = 0.012), while diabetes was not associated with long-term mortality. Further adjustment with AGP did not change the estimates. Conclusion: Diabetes considerably increases risk of early mortality during TB treatment. The effect may not be explained by increased severity of TB, but could be due to impaired TB treatment response. Research is needed to clarify the mechanism and to assess whether glycaemic control improves survival.",

keywords = "Blood Glucose, Diabetes Complications, Female, HIV Infections, Humans, Male, Middle Aged, Orosomucoid, Prospective Studies, Risk Factors, Tanzania, Treatment Outcome, Tuberculosis, Pulmonary, Young Adult",

author = "Daniel Faurholt-Jepsen and Nyagosya Range and George PrayGod and Kidola Jeremiah and Maria Faurholt-Jepsen and Martine Aabye and John Changalucha and Christensen, {Dirk Lund} and Grewal, {Harleen M S} and Torben Martinussen and Henrik Krarup and Witte, {Daniel R} and Andersen, {Aase B} and Henrik Friis",

note = "CURIS 2013 NEXS 210",

year = "2013",

month = jul,

doi = "10.1111/tmi.12120",

language = "English",

volume = "18",

pages = "822--829",

journal = "Tropical Medicine & International Health",

issn = "1360-2276",

publisher = "Wiley-Blackwell",

number = "7",

}

TY - JOUR

T1 - Diabetes is a strong predictor of mortality during tuberculosis treatment

T2 - a prospective cohort study among tuberculosis patients from Mwanza, Tanzania

AU - Faurholt-Jepsen, Daniel

AU - Range, Nyagosya

AU - PrayGod, George

AU - Jeremiah, Kidola

AU - Faurholt-Jepsen, Maria

AU - Aabye, Martine

AU - Changalucha, John

AU - Christensen, Dirk Lund

AU - Grewal, Harleen M S

AU - Martinussen, Torben

AU - Krarup, Henrik

AU - Witte, Daniel R

AU - Andersen, Aase B

AU - Friis, Henrik

N1 - CURIS 2013 NEXS 210

PY - 2013/7

Y1 - 2013/7

N2 - Objective: Strong evidence suggests diabetes may be associated with tuberculosis (TB) and could influence TB treatment outcomes. We assessed the role of diabetes on sputum culture conversion and mortality among patients undergoing TB treatment. Methods: A total of 1250 Tanzanian TB patients were followed prospectively during TB treatment with sputum culture after 2 and 5 months. Survival status was assessed at least 1 year after initiation of treatment. At baseline, all participants underwent testing for diabetes and HIV, and the serum concentration of the acute phase reactant alpha-1 glycoprotein (AGP) was determined. Results: There were no differences between participants with and without diabetes regarding the proportion of positive cultures at 2 (3.8% vs. 5.8%) and 5 (1.3% vs. 0.9%) months (P > 0.46). However, among patients with a positive TB culture, relatively more patients with diabetes died before the 5-month follow-up. Within the initial 100 days of TB treatment, diabetes was associated with a fivefold increased risk of mortality (RR 5.09, 95% CI 2.36; 11.02, P < 0.001) among HIV uninfected, and a twofold increase among HIV co-infected patient (RR 2.33 95% CI 1.20; 4.53, P = 0.012), while diabetes was not associated with long-term mortality. Further adjustment with AGP did not change the estimates. Conclusion: Diabetes considerably increases risk of early mortality during TB treatment. The effect may not be explained by increased severity of TB, but could be due to impaired TB treatment response. Research is needed to clarify the mechanism and to assess whether glycaemic control improves survival.

AB - Objective: Strong evidence suggests diabetes may be associated with tuberculosis (TB) and could influence TB treatment outcomes. We assessed the role of diabetes on sputum culture conversion and mortality among patients undergoing TB treatment. Methods: A total of 1250 Tanzanian TB patients were followed prospectively during TB treatment with sputum culture after 2 and 5 months. Survival status was assessed at least 1 year after initiation of treatment. At baseline, all participants underwent testing for diabetes and HIV, and the serum concentration of the acute phase reactant alpha-1 glycoprotein (AGP) was determined. Results: There were no differences between participants with and without diabetes regarding the proportion of positive cultures at 2 (3.8% vs. 5.8%) and 5 (1.3% vs. 0.9%) months (P > 0.46). However, among patients with a positive TB culture, relatively more patients with diabetes died before the 5-month follow-up. Within the initial 100 days of TB treatment, diabetes was associated with a fivefold increased risk of mortality (RR 5.09, 95% CI 2.36; 11.02, P < 0.001) among HIV uninfected, and a twofold increase among HIV co-infected patient (RR 2.33 95% CI 1.20; 4.53, P = 0.012), while diabetes was not associated with long-term mortality. Further adjustment with AGP did not change the estimates. Conclusion: Diabetes considerably increases risk of early mortality during TB treatment. The effect may not be explained by increased severity of TB, but could be due to impaired TB treatment response. Research is needed to clarify the mechanism and to assess whether glycaemic control improves survival.

KW - Blood Glucose

KW - Diabetes Complications

KW - Female

KW - HIV Infections

KW - Humans

KW - Male

KW - Middle Aged

KW - Orosomucoid

KW - Prospective Studies

KW - Risk Factors

KW - Tanzania

KW - Treatment Outcome

KW - Tuberculosis, Pulmonary

KW - Young Adult

U2 - 10.1111/tmi.12120

DO - 10.1111/tmi.12120

M3 - Journal article

C2 - 23648145

SN - 1360-2276

VL - 18

SP - 822

EP - 829

JO - Tropical Medicine & International Health

JF - Tropical Medicine & International Health

IS - 7

ER -

Diabetes is a strong predictor of mortality during tuberculosis treatment: a prospective cohort study among tuberculosis patients from Mwanza, Tanzania

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