The Effect of Diabetes Mellitus on the Treatment Outcome of Tuberculosis

Introduction: Tuberculosis and diabetes mellitus both are the two most important public health problems inIndia. India is presently having the highest burden of tuberculosis and second highest burden of diabetes mellitusglobally. Many studies have shown to have poorer treatment outcome of tuberculosis in diabetic patients.Aim: To evaluate the difference in treatment outcome antitubercular regimens in diabetic patients compared tonon-diabetic patients.Materials and Methods: Active tuberculosis patients presenting to Department of Respiratory Medicine ofIPGME&R, Kolkata were taken and divided into two groups- with and without diabetes mellitus (according toADA criteria). Two groups were matched for age, sex, addiction habits, history of contact with tuberculosis andprevious treatment for tuberculosis. Treatment for tuberculosis and diabetes mellitus have been given to boththe groups according to standard protocol and they are followed up for glycemic control, treatment outcome fortuberculosis (according to standard outcome parameters and clinicoradiological outcome) including adverse drugreaction, need for hospitalization and mortality. Statistical analysis was also done to evaluate accuracy of HbA1c atthe end of treatment to predict the clinicoradiological outcome.Results: In this outcome analysis, patients with tuberculosis and diabetes have poorer clinicoradiological outcome(36%) and unsuccessful treatment outcome (10%), higher rate of hospitalisation(OR=8.5) and mortality (4%). ROCcurve analysis showed a cut-off HbA1c<7.4 to have a good clinicoradiological outcome at end of treatment.Conclusion: Diabetes has negative effect on outcome of anti-tubercular treatment as poor glycemic control duringthe course of treatment often lead to poor outcome of tuberculosis. So every tuberculosis patient should be screenedfor diabetes mellitus at the onset of treatment and proper anti-diabetic therapy is to be given along with standardanti-tubercular treatment for favourable outcome.