title: Association of diabetes and tuberculosis: impact on treatment and post-treatment outcomes.
abstract: OBJECTIVE
  To determine the clinical consequences of pulmonary tuberculosis (TB) among patients with diabetes mellitus (DM).
  
  
  METHODS
  We conducted a prospective study of patients with TB in Southern Mexico. From 1995 to 2010, patients with acid-fast bacilli or Mycobacterium tuberculosis in sputum samples underwent epidemiological, clinical and microbiological evaluation. Annual follow-ups were performed to ascertain treatment outcome, recurrence, relapse and reinfection.
  
  
  RESULTS
  The prevalence of DM among 1262 patients with pulmonary TB was 29.63% (n=374). Patients with DM and pulmonary TB had more severe clinical manifestations (cavities of any size on the chest x-ray, adjusted OR (aOR) 1.80, 95% CI 1.35 to 2.41), delayed sputum conversion (aOR 1.51, 95% CI 1.09 to 2.10), a higher probability of treatment failure (aOR 2.93, 95% CI 1.18 to 7.23), recurrence (adjusted HR (aHR) 1.76, 95% CI 1.11 to 2.79) and relapse (aHR 1.83, 95% CI 1.04 to 3.23). Most of the second episodes among patients with DM were caused by bacteria with the same genotype but, in 5/26 instances (19.23%), reinfection with a different strain occurred.
  
  
  CONCLUSIONS
  Given the growing epidemic of DM worldwide, it is necessary to add DM prevention and control strategies to TB control programmes and vice versa and to evaluate their effectiveness. The concurrence of both diseases potentially carries a risk of global spreading, with serious implications for TB control and the achievement of the United Nations Millennium Development Goals.
authors.affiliation: Laboratorios de Biológicos y Reactivos de México (BIRMEX), , Ciudad de México, Distrito Federal México,  México.
authors.forename: María Eugenia
authors.initials: ME
authors.lastname: Jiménez-Corona
authors.forename: Luis Pablo
authors.initials: LP
authors.lastname: Cruz-Hervert
authors.forename: Lourdes
authors.initials: L
authors.lastname: García-García
authors.forename: Leticia
authors.initials: L
authors.lastname: Ferreyra-Reyes
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Delgado-Sánchez
authors.forename: Miriam
authors.initials: M
authors.lastname: Bobadilla-Del-Valle
authors.forename: Sergio
authors.initials: S
authors.lastname: Canizales-Quintero
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ferreira-Guerrero
authors.forename: Renata
authors.initials: R
authors.lastname: Báez-Saldaña
authors.forename: Norma
authors.initials: N
authors.lastname: Téllez-Vázquez
authors.forename: Rogelio
authors.initials: R
authors.lastname: Montero-Campos
authors.forename: Norma
authors.initials: N
authors.lastname: Mongua-Rodriguez
authors.forename: Rosa Areli
authors.initials: RA
authors.lastname: Martínez-Gamboa
authors.forename: José
authors.initials: J
authors.lastname: Sifuentes-Osornio
authors.forename: Alfredo
authors.initials: A
authors.lastname: Ponce-de-León
mesh_terms: D000328:Adult; D000368:Aged; D015897:Comorbidity; D016001:Confidence Intervals; D016172:DNA Fingerprinting; D048909:Diabetes Complications / Q000453:epidemiology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000235:genetics; D016017:Odds Ratio; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult