title: Impact of diabetes on treatment outcomes and long-term survival in multidrug-resistant tuberculosis.
abstract: BACKGROUND
  Few studies have investigated the impact of diabetes mellitus (DM), a globally increasing metabolic disease, on treatment outcomes and long-term survival in patients with multidrug-resistant forms of tuberculosis (MDR-TB).
  
  
  OBJECTIVE
  We analyzed outcomes in a large cohort to assess the impact of DM on treatment outcomes of patients with MDR-TB.
  
  
  METHODS
  MDR-TB patients newly diagnosed or retreated between 2000 and 2002 and followed for 8-11 years were retrospectively analyzed with respect to the effect of DM as a comorbidity on their treatment outcome and long-term survival.
  
  
  RESULTS
  Of 1,407 patients with MDR-TB, 239 (17.0%) had coexisting DM. The mean age and body mass index were higher in MDR-TB patients with DM [MDR-TBDM(+)] than in those without DM [MDR-TBDM(-)]. Patients with MDR-TB and a comorbidity of DM had a significantly lower treatment success rate than those without a history of DM (36.0 vs. 47.2%, p = 0.002). In addition, DM was the negative predictor for MDR-TB treatment success in multivariate analyses [odds ratio 0.51, 95% confidence interval (CI) 0.26-0.99]. Mean survival times were also lower in MDR-TBDM(+) than in MDR-TBDM(-) patients (102 vs. 114 months, p = 0.001), with DM as a significant predictor of poor long-term survival in multivariate analyses (hazard ratio 1.59, 95% CI 1.01-2.50).
  
  
  CONCLUSIONS
  Among MDR-TB patients, DM was a relatively common comorbidity. In patients undergoing treatment for MDR-TB and followed for 8-11 years, it was found to be independently associated with an increased risk of both treatment failure and death.
authors.affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Young Ae
authors.initials: YA
authors.lastname: Kang
authors.forename: Song Yee
authors.initials: SY
authors.lastname: Kim
authors.forename: Kyung-Wook
authors.initials: KW
authors.lastname: Jo
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Kim
authors.forename: Seung-Kyu
authors.initials: SK
authors.lastname: Park
authors.forename: Tae-Hyung
authors.initials: TH
authors.lastname: Kim
authors.forename: Eun Kyung
authors.initials: EK
authors.lastname: Kim
authors.forename: Ki Man
authors.initials: KM
authors.lastname: Lee
authors.forename: Sung Soon
authors.initials: SS
authors.lastname: Lee
authors.forename: Jae Seuk
authors.initials: JS
authors.lastname: Park
authors.forename: Won-Jung
authors.initials: WJ
authors.lastname: Koh
authors.forename: Dae Yun
authors.initials: DY
authors.lastname: Kim
authors.forename: Tae Sun
authors.initials: TS
authors.lastname: Shim
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015992:Body Mass Index; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D017211:Treatment Failure; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents