{"id":50415,"date":"2023-09-30T10:24:53","date_gmt":"2023-09-30T10:24:53","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=50415"},"modified":"2023-10-07T11:48:43","modified_gmt":"2023-10-07T11:48:43","slug":"prevalence-of-diabetes-mellitus-among-newly-detected-sputum-positive-pulmonary-tuberculosis-patients-and-associated-risk-factors","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol16no3\/prevalence-of-diabetes-mellitus-among-newly-detected-sputum-positive-pulmonary-tuberculosis-patients-and-associated-risk-factors\/","title":{"rendered":"Prevalence of Diabetes Mellitus Among Newly Detected Sputum Positive Pulmonary Tuberculosis Patients and Associated Risk Factors."},"content":{"rendered":"\n

Introduction<\/strong><\/p>\n\n\n\n

With\nurbanization as well as social and economic development, there has been a\nrapidly growing prevalence of DM. People with a weak immune system such as\ndiabetes, are at a higher risk of progressing from latent to active disease. So\npeople with DM have a 2-3 times higher risk of getting TB when compared to\npeople without DM.2<\/sup> About 10% of TB cases in the world are linked to\nDM.1<\/sup> A large proportion of people living with DM as well as TB are\nnot diagnosed or diagnosed too late. Therefore, early detection can help\nimprove the care and effective control of both diseases. <\/p>\n\n\n\n

DM\ncan increase the time taken to sputum culture conversion and thus it leads to\nthe development of drug resistance if a 4 drug regimen in the intensive phase\nis changed to 2 drug regimen after 2 months in the presence of culture-positive\ntime1<\/sup> People living with DMTB have a higher risk of death during\ntreatment and risk of TB relapse after completing treatment. DM is complicated\nby the presence of infectious diseases, including TB. It has also been observed\nthat good glycaemic control in TB patients can improve treatment outcomes.\nRecent studies have shown that DM accounts for 20% of smear-positive TB and\nhave indicated that an increase in DM prevalence in India has been an important\nobstacle to reducing TB prevalence2<\/sup><\/p>\n\n\n\n

There\nis a lack of literature regarding this comorbidity in our area. Therefore, this\nstudy was conducted to know the prevalence of DM among TB patients in Vijayapura\ntaluk.  And to\nstudy the socio-demographic profile of tuberculosis patients with diabetes\nmellitus and also to identify the risk factors.<\/p>\n\n\n\n

Material and methods<\/strong><\/p>\n\n\n\n

Ethical clearance was obtained from the Institutional Ethical Committee of Shri B M Patil Medical College, BLDE University (Certificate No \u2013 65\/21-10-17). The present study was a cross-sectional study done at Vijayapura TU.  It covers 14 primary health centres, 4 urban health centres and 2 medical colleges. A tuberculosis register was used to approach the TB patients. More than 18 years of age sputum positive TB cases of Vijayapura taluk registered from January 1st<\/sup> to December 31st<\/sup> 2016 were included. Patients who are critically ill, not willing to participate, and pregnant and lactating women were not included in the study. Considering the prevalence of diabetes mellitus among tuberculosis patients to be 30.6%3<\/sup>,  at a 95% confidence level and at 20% allowable error, the sample size is calculated by using the formula<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Apparently, non-diabetic patients were screened for DM by examining blood glucose levels in capillary blood using a finger-prick glucometer. Those found positive and having symptoms of DM were further evaluated by doing random blood glucose levels. Health workers\/ASHAs were involved in the study. Objectives were explained to them. The TB patients were approached at their homes\/DOTS centres\/PHCs with the help of the Senior Treatment Supervisor. The Procedure included 3 parts i.e., an interview through semi structured questionnaire, anthropometric measurements and blood glucose estimation. Classification of DM was done using American Diabetic Association. The detected DM patient\u2019s house was revisited and health education was given. The data was compiled in a   Microsoft Excelworksheet sheet and analysed using Statistical Package for Social Sciences (SPSS) version 16.0 software. The data was presented in the form of tables and graphs wherever necessary. All characteristics were summarized descriptively. For continuous variables, the summary statistics of n, mean, and standard deviation about the arithmetic mean (SD) were used. For categorical data, the number and percentage were used in the data summarized. Chi-square test will be used to know the significant association. P-value less than 0.05 will be considered statistically significant.<\/p>\n\n\n\n

Table 1: Distribution of sociodemographic characteristics of study participants (n=215)<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Study variable<\/strong><\/p>\n<\/td>\n

\n

Number (n)<\/strong><\/p>\n<\/td>\n

\n

Percentage (%)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Age (yrs.)<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

15-25<\/p>\n<\/td>\n

\n

32<\/p>\n<\/td>\n

\n

14.9<\/p>\n<\/td>\n<\/tr>\n

\n

26-35<\/p>\n<\/td>\n

\n

58<\/p>\n<\/td>\n

\n

27.0<\/p>\n<\/td>\n<\/tr>\n

\n

36-45<\/p>\n<\/td>\n

\n

45<\/p>\n<\/td>\n

\n

20.9<\/p>\n<\/td>\n<\/tr>\n

\n

46-55<\/p>\n<\/td>\n

\n

47<\/p>\n<\/td>\n

\n

21.9<\/p>\n<\/td>\n<\/tr>\n

\n

56-65<\/p>\n<\/td>\n

\n

26<\/p>\n<\/td>\n

\n

12.0<\/p>\n<\/td>\n<\/tr>\n

\n

>65<\/p>\n<\/td>\n

\n

7<\/p>\n<\/td>\n

\n

3.3<\/p>\n<\/td>\n<\/tr>\n

\n

Sex<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Male<\/p>\n<\/td>\n

\n

138<\/p>\n<\/td>\n

\n

64.2<\/p>\n<\/td>\n<\/tr>\n

\n

Female<\/p>\n<\/td>\n

\n

77<\/p>\n<\/td>\n

\n

35.8<\/p>\n<\/td>\n<\/tr>\n

\n

Place<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Rural<\/p>\n<\/td>\n

\n

190<\/p>\n<\/td>\n

\n

88.0<\/p>\n<\/td>\n<\/tr>\n

\n

Urban<\/p>\n<\/td>\n

\n

25<\/p>\n<\/td>\n

\n

12.0<\/p>\n<\/td>\n<\/tr>\n

\n

Marital status<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Married<\/p>\n<\/td>\n

\n

193<\/p>\n<\/td>\n

\n

89.8<\/p>\n<\/td>\n<\/tr>\n

\n

Unmarried<\/p>\n<\/td>\n

\n

17<\/p>\n<\/td>\n

\n

7.9<\/p>\n<\/td>\n<\/tr>\n

\n

Widowed<\/p>\n<\/td>\n

\n

5<\/p>\n<\/td>\n

\n

2.3<\/p>\n<\/td>\n<\/tr>\n

\n

Religion<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Hindu<\/p>\n<\/td>\n

\n

189<\/p>\n<\/td>\n

\n

87.9<\/p>\n<\/td>\n<\/tr>\n

\n

Muslim<\/p>\n<\/td>\n

\n

26<\/p>\n<\/td>\n

\n

12.1<\/p>\n<\/td>\n<\/tr>\n

\n

Education<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Illiterate<\/p>\n<\/td>\n

\n

32<\/p>\n<\/td>\n

\n

14.9<\/p>\n<\/td>\n<\/tr>\n

\n

Primary<\/p>\n<\/td>\n

\n

117<\/p>\n<\/td>\n

\n

54.4<\/p>\n<\/td>\n<\/tr>\n

\n

Secondary<\/p>\n<\/td>\n

\n

51<\/p>\n<\/td>\n

\n

23.7<\/p>\n<\/td>\n<\/tr>\n

\n

PUC<\/p>\n<\/td>\n

\n

14<\/p>\n<\/td>\n

\n

6.5<\/p>\n<\/td>\n<\/tr>\n

\n

Graduate<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

0.5<\/p>\n<\/td>\n<\/tr>\n

\n

Type of Family<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Nuclear<\/p>\n<\/td>\n

\n

187<\/p>\n<\/td>\n

\n

87.0<\/p>\n<\/td>\n<\/tr>\n

\n

Joint<\/p>\n<\/td>\n

\n

28<\/p>\n<\/td>\n

\n

13.0<\/p>\n<\/td>\n<\/tr>\n

\n

Socioeconomic class<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Upper class<\/p>\n<\/td>\n

\n

4<\/p>\n<\/td>\n

\n

1.9<\/p>\n<\/td>\n<\/tr>\n

\n

Upper middle class<\/p>\n<\/td>\n

\n

8<\/p>\n<\/td>\n

\n

3.7<\/p>\n<\/td>\n<\/tr>\n

\n

Middle class<\/p>\n<\/td>\n

\n

55<\/p>\n<\/td>\n

\n

25.6<\/p>\n<\/td>\n<\/tr>\n

\n

Lower middle class<\/p>\n<\/td>\n

\n

43<\/p>\n<\/td>\n

\n

20.0<\/p>\n<\/td>\n<\/tr>\n

\n

Lower class<\/p>\n<\/td>\n

\n

105<\/p>\n<\/td>\n

\n

48.8<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

The above table \u2013 1 shows that out of 215 study participants, majority (27%) of them belonged to age group of 26-35 yrs followed by 46-55 yrs (21.9%) and 36-45 yrs (20.9%). This shows that most of the study participants were in reproductive age 36 group. In our study males were predominant i.e. 64.2% (138) and females constituted 35.8% (77). 88% of the tuberculosis patients were from rural background. 89.8% of the study participants were married and only 7.9% were unmarried and there were about 2.3 % widowed participants in the study. 87.9% of study participants belonged to Hindu religion and rest of them i.e. 12.1% belonged to Muslim community. More than half (54.4%) of the study participants studied up to primary school followed by secondary school (23.7%) and there were 14.9% of illiterates in the study. In this study 87% (187) of the participants belonged to nuclear family while 13% (28) were from the joint family. In our study 48.8% of the participants belonged to lower class according to modified B G Prasad\u2019s classification followed by 25.6% to middle class and 20% to lower middle class.<\/p>\n\n\n\n\n\n
\"\"<\/td>\n\n

Figure 1: Distribution of cases according to <\/strong>IP\/CP (n= 215)<\/strong><\/p>\n

<\/p>\n

Click here to view Figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

In Figure 1- Out of 215 study participants, 74% (159) were in the continuation phase of the TB treatment and 26% (56) were in the intensive phase.<\/p>\n\n\n\n

Table 2: Distribution of cases according to Treatment Adherence (n=215)<\/strong><\/p>\n\n\n\n\n\n\n\n\n
\n

Treatment Adherence<\/strong><\/p>\n<\/td>\n

\n

N<\/strong><\/p>\n<\/td>\n

\n

Percent<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

No<\/p>\n<\/td>\n

\n

23<\/p>\n<\/td>\n

\n

10.6<\/p>\n<\/td>\n<\/tr>\n

\n

Yes<\/p>\n<\/td>\n

\n

192<\/p>\n<\/td>\n

\n

89.4<\/p>\n<\/td>\n<\/tr>\n

\n

Total<\/p>\n<\/td>\n

\n

215<\/p>\n<\/td>\n

\n

100.0<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

The above table- 2 details the prevalence of Anti-TB treatment adherence. It was found that nearly 10.6% of the study participants were non-adherent to the treatment course. <\/p>\n\n\n\n\n\n
\"\"<\/td>\n\n

Figure 2: Distribution of <\/strong>Prevalence of DM among TB patients.<\/strong><\/p>\n

<\/p>\n

Click here to view Figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

In Figure \u2013 2 Out of 215 study participants the prevalence of diabetes mellitus was 23.7% (51).<\/p>\n\n\n\n

Table 3: Distribution of behavioural patterns among participants with DM (n=51)<\/strong>.<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

Study variable<\/strong><\/p>\n<\/td>\n

\n

Number(n)<\/strong><\/p>\n<\/td>\n

\n

Percentage (%)<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Food Habits<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Vegetarian<\/p>\n<\/td>\n

\n

25<\/p>\n<\/td>\n

\n

49<\/p>\n<\/td>\n<\/tr>\n

\n

Mixed<\/p>\n<\/td>\n

\n

26<\/p>\n<\/td>\n

\n

51<\/p>\n<\/td>\n<\/tr>\n

\n

Smoking<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Current smoker<\/p>\n<\/td>\n

\n

22<\/p>\n<\/td>\n

\n

43.1<\/p>\n<\/td>\n<\/tr>\n

\n

Ex-Smoker<\/p>\n<\/td>\n

\n

26<\/p>\n<\/td>\n

\n

51<\/p>\n<\/td>\n<\/tr>\n

\n

Non-Smoker<\/p>\n<\/td>\n

\n

3<\/p>\n<\/td>\n

\n

5.9<\/p>\n<\/td>\n<\/tr>\n

\n

Alcohol Consumption<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Alcoholic<\/p>\n<\/td>\n

\n

15<\/p>\n<\/td>\n

\n

29.4<\/p>\n<\/td>\n<\/tr>\n

\n

Non-Alcoholic<\/p>\n<\/td>\n

\n

36<\/p>\n<\/td>\n

\n

70.6<\/p>\n<\/td>\n<\/tr>\n

\n

Occupation<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Non-Government<\/p>\n<\/td>\n

\n

39<\/p>\n<\/td>\n

\n

76.5<\/p>\n<\/td>\n<\/tr>\n

\n

Government<\/p>\n<\/td>\n

\n

4<\/p>\n<\/td>\n

\n

7.8<\/p>\n<\/td>\n<\/tr>\n

\n

Housewife<\/p>\n<\/td>\n

\n

7<\/p>\n<\/td>\n

\n

13.7<\/p>\n<\/td>\n<\/tr>\n

\n

Student<\/p>\n<\/td>\n

\n

1<\/p>\n<\/td>\n

\n

2<\/p>\n<\/td>\n<\/tr>\n

\n

Physical Activity<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

Sedentary<\/p>\n<\/td>\n

\n

2<\/p>\n<\/td>\n

\n

3.9<\/p>\n<\/td>\n<\/tr>\n

\n

Moderate<\/p>\n<\/td>\n

\n

46<\/p>\n<\/td>\n

\n

90.2<\/p>\n<\/td>\n<\/tr>\n

\n

Heavy<\/p>\n<\/td>\n

\n

3<\/p>\n<\/td>\n

\n

5.9<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Table -3 details are as follows; When looking at the food habits of the study participants 49 % were vegetarians and 51% used to consume both vegetarian and non-vegetarian food items. 43.1% of the study participants were current smokers and 51s% were ex-smokers; however, 5.9% were non-smokers. A majority (70.6%) of the study participants were non-alcoholic and about 29.4 % used to consume alcohol. Most (90.2%) of the study participants were engaged in moderate activity followed by 3.9% and 5.9% in sedentary and heavy work respectively.<\/p>\n\n\n\n

Discussion<\/strong><\/p>\n\n\n\n

Our\nstudy showed that the majority of the tuberculosis patients were in the age\ngroup of 26-35 years (27%). Similar results were found in a study done4<\/sup>\nin Addis Ababa Ethiopia where the majority of the patients were 25- 44 years of\nage. A study done5<\/sup> <\/em>in\nKerala revealed that most of the patients were 45-54 years of age. Few other\nstudies done6<\/sup><\/em> in Patiala\nPunjab and in Ahemdabad7<\/sup><\/em>\nreported 40-60 years\u2019 age group as most commonly involved. This difference in\nan age group may be due to the different locations of the study and study\ndesign setting. The mean age was found to be 52.1 yrs among diabetics and 37.1\namong non-diabetics which is similar to a study8 <\/sup>in Tamil Nadu where\nthemean age of the DM TB patients was 52.92 yrs and was statistically\nsignificant. In Andhra Pradesh showed the mean age as 46.5\u00b110.3 among diabetics\nand 35.8\u00b111.7 among non-diabetics3<\/sup>.<\/p>\n\n\n\n

 More than half 54.4% (117) tuberculosis patients\nstudied up to primary schooling, 23.7% (51) patients completed high school\neducation and 14.9% (32) patients were illiterates, where it was observed that\nmost of the TB patients had received less schooling, which was consistent with\nother studies. A study done9 <\/sup>in Bangladesh reported that 25.1% of\nthe participants had primary schooling, 19.8% had secondary schooling and 40.7%\nwere illiterates. Another study 10 <\/sup>in Pakistan has shown 51.6% as\nilliterates, 34.7% as primary schooling and 10.7% as secondary schooling.  <\/p>\n\n\n\n

In\nour study, 4.7% of participants were current smokers and 69.3% were non-smokers\nwhich is in line with a study4 <\/sup>in Ethiopia which revealed 15% as\nsmokers and 85% as non-smokers. But another study done11<\/sup><\/em> in Nigeria showed 4.8% as non-smokers and 95.2% as\ncurrent smokers. This variation may be due to change in the social scenario.<\/p>\n\n\n\n

We\nfound that majority (84.2%) of the TB patients were non-alcoholic and about\n15.8% used to consume alcohol similar to a study12<\/sup><\/em> in Tamil Nadu in which 38.9% were non-alcoholic and\n1.6% were alcoholic. But another study4 <\/sup>in Ethiopia had no much\ndifference in alcohol consumption i.e 51.7% as non-alcoholic and 48.3% as\nalcoholic which may be due to different socio- cultural factors.  <\/p>\n\n\n\n

The\nprevalence of DM among TB patients in our study was 23.7% which is in\nconsistent reports of other studies13<\/sup> done in Karnataka State in\n2011 where the prevalence was 32%, in Kerala State 44% (2012) and Tamil Nadu\nState, India 25% (2012). Other studies like an institutional based cross-sectional\nstudy3 <\/sup>in Andhra Pradesh showed the prevalence of DM as 30.6%. A\nfacility based cross-sectional study done14 <\/sup>in Puducherry (2017)\nreported 29% as DM prevalence. In contrast to the above findings, another study\ndone in Nigeria.15<\/sup><\/em> found\nthe prevalence to be 5.7% which could be attributed to the difference in\ndemographic characteristics. We employed American Diabetic Association (ADA)\ncriteria to assess the diabetes mellitus and studied tuberculosis patients\nregistered under RNTCP. <\/p>\n\n\n\n

Few\nof the variables analysed were based on the information obtained by the study\nparticipants hence an element of recall bias and masking of data could be\npresent. TB patients registered under RNTCP were included in the study;\npatients taking treatment in private hospitals may have missed. Among all the\nTB patients only new sputum-positive pulmonary TB patients were included which\nmay be the limitation. In the present study few risk factors of DM were\nstudied. All other risk factors could not be studied because of lack of\nresources. The prevalence of DM among TB patients was 23.7% which is quite high\nso screening of all TB patients should be done just like HIV screening which\nwill help in early diagnosis and proper management of the disease. For DMTB\npatients, regular blood glucose estimation and treatment should be given in\nDOTS centres along with anti-TB drugs. Primordial prevention can play an\nimportant role in preventing the occurrence of DM. Health education regarding\nthe risk factors and symptoms of DM should be given to high risk groups.   <\/p>\n\n\n\n

Though\nthe results were found to be consistent with those reported by other authors\ndirect comparisons are not valid for the reasons detailed above and also relate\nto different criteria used by researchers over time to diagnose both\nconditions, non-representativeness of patients studied both in terms of number\nand selection criteria and different settings. A well planned large scale\nobservational study or meta-analysis has the potential to settle the issue.<\/p>\n\n\n\n

Conclusion<\/strong><\/p>\n\n\n\n

Routine\nscreening for DM in TB patients is mandatory due to   increase in the prevalence of DM which would\nnot only help in early diagnosis but also reduces the complications by proper\nmanagement and  in turn will help in\nsuccessful outcome of TB treatment. <\/p>\n\n\n\n

Conflicts of Interest<\/strong><\/p>\n\n\n\n

There are no conflict of Interest.<\/p>\n\n\n\n

Funding Sources<\/strong><\/p>\n\n\n\n

There is no funding sources.<\/p>\n\n\n\n

References<\/strong><\/p>\n\n\n\n

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