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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
The impact of diabetes on tuberculosis treatment outcomes: A systematic review
BMC Medicine, Volume 9, Article 81, Year 2011
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Description
Background: Multiple studies of tuberculosis treatment have indicated that patients with diabetes mellitus may experience poor outcomes.We performed a systematic review and meta-analysis to quantitatively summarize evidence for the impact of diabetes on tuberculosis outcomes.Methods: We searched PubMed, EMBASE and the World Health Organization Regional Indexes from 1 January 1980 to 31 December 2010 and references of relevant articles for reports of observational studies that included people with diabetes treated for tuberculosis. We reviewed the full text of 742 papers and included 33 studies of which 9 reported culture conversion at two to three months, 12 reported the combined outcome of failure and death, 23 reported death, 4 reported death adjusted for age and other potential confounding factors, 5 reported relapse, and 4 reported drug resistant recurrent tuberculosis.Results: Diabetes is associated with an increased risk of failure and death during tuberculosis treatment. Patients with diabetes have a risk ratio (RR) for the combined outcome of failure and death of 1.69 (95% CI, 1.36 to 2.12). The RR of death during tuberculosis treatment among the 23 unadjusted studies is 1.89 (95% CI, 1.52 to 2.36), and this increased to an effect estimate of 4.95 (95% CI, 2.69 to 9.10) among the 4 studies that adjusted for age and other potential confounding factors. Diabetes is also associated with an increased risk of relapse (RR, 3.89; 95% CI, 2.43 to 6.23). We did not find evidence for an increased risk of tuberculosis recurrence with drug resistant strains among people with diabetes. The studies assessing sputum culture conversion after two to three months of tuberculosis therapy were heterogeneous with relative risks that ranged from 0.79 to 3.25.Conclusions: Diabetes increases the risk of failure and death combined, death, and relapse among patients with tuberculosis. This study highlights a need for increased attention to treatment of tuberculosis in people with diabetes, which may include testing for suspected diabetes, improved glucose control, and increased clinical and therapeutic monitoring. © 2011 Baker et al; licensee BioMed Central Ltd.
Available Materials
https://efashare.b-cdn.net/share/pmc/articles/PMC3155828/bin/1741-7015-9-81-S1.PPT
https://efashare.b-cdn.net/share/pmc/articles/PMC3155828/bin/1741-7015-9-81-S2.PPT
https://efashare.b-cdn.net/share/pmc/articles/PMC3155828/bin/1741-7015-9-81-S3.PPT
https://efashare.b-cdn.net/share/pmc/articles/PMC3155828/bin/1741-7015-9-81-S4.PPT
https://efashare.b-cdn.net/share/pmc/articles/PMC3155828/bin/1741-7015-9-81-S5.PPT
https://efashare.b-cdn.net/share/pmc/articles/PMC3155828/bin/1741-7015-9-81-S6.PPT
Authors & Co-Authors
Baker, Meghan A.
United States, Boston
Massachusetts General Hospital
United States, Boston
Harvard T.h. Chan School of Public Health
Harries, Anthony David
France, Paris
International Union Against Tuberculosis and Lung Disease
United Kingdom, London
London School of Hygiene & Tropical Medicine
Jeon, Christie Younghae
United States, New York
Columbia University
United States, Boston
Harvard T.h. Chan School of Public Health
Kapur, Anil
Unknown Affiliation
Lö̈nnroth, Knut
Switzerland, Geneva
Organisation Mondiale de la Santé
Ottmani, Salah Eddine
Switzerland, Geneva
Organisation Mondiale de la Santé
Goonesekera, Sunali D.
United States, Boston
Harvard T.h. Chan School of Public Health
Murray, Megan B.
United States, Boston
Harvard T.h. Chan School of Public Health
United States, Boston
Brigham and Women's Hospital
Statistics
Citations: 719
Authors: 8
Affiliations: 8
Identifiers
Doi:
10.1186/1741-7015-9-81
ISSN:
17417015
Research Areas
Noncommunicable Diseases
Study Approach
Systematic review