High diabetes prevalence among tuberculosis cases in Kerala, India.
BACKGROUND
While diabetes mellitus (DM) is a known risk factor for tuberculosis, the prevalence among TB patients in India is unknown. Routine screening of TB patients for DM may be an opportunity for its early diagnosis and improved management and might improve TB treatment outcomes. We conducted a cross-sectional survey of TB patients registered from June-July 2011 in the state of Kerala, India, to determine the prevalence of DM.


RESULTS
A state-wide representative sample of TB patients in Kerala was interviewed and screened for DM using glycosylated hemoglobin (HbA1c); patients self-reporting a history of DM or those with HbA1c ≥6.5% were defined as diabetic. Among 552 TB patients screened, 243(44%) had DM - 128(23%) had previously known DM and 115(21%) were newly diagnosed - with higher prevalence among males and those aged >50 years. The number needed to screen(NNS) to find one newly diagnosed case of DM was just four. Of 128 TB patients with previously known DM, 107(84%) had HbA1c ≥7% indicating poor glycemic control.


CONCLUSIONS
Nearly half of TB patients in Kerala have DM, and approximately half of these patients were newly-diagnosed during this survey. Routine screening of TB patients for DM using HbA1c yielded a large number of DM cases and offered earlier management opportunities which may improve TB and DM outcomes. However, the most cost-effective ways of DM screening need to be established by futher operational research.
Department of Tuberculosis, Office of the WHO Representative to India, New Delhi, India. balakrishnans@rntcp.org
Shibu
S
Balakrishnan
Shibu
S
Vijayan
Sanjeev
S
Nair
Jayasankar
J
Subramoniapillai
Sunilkumar
S
Mrithyunjayan
Nevin
N
Wilson
Srinath
S
Satyanarayana
Puneet K
PK
Dewan
Ajay M V
AM
Kumar
Durai
D
Karthickeyan
Matthew
M
Willis
Anthony D
AD
Harries
Sreenivas Achuthan
SA
Nair
D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014376:Tuberculosis / Q000150:complications / Q000453:epidemiology*
D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human