Glycemic control and radiographic manifestations of tuberculosis in diabetic patients.
BACKGROUND
Radiographic manifestations of pulmonary tuberculosis (TB) in patients with diabetes mellitus (DM) have previously been reported, with inconsistent results. We conducted a study to investigate whether glycemic control has an impact on radiographic manifestations of pulmonary TB.


METHODS
Consecutive patients with culture-positive pulmonary TB who had DM in three tertiary care hospitals from 2005-2010 were selected for review and compared with a similar number without DM. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C). A pre-treatment chest radiograph was read independently by two qualified pulmonologists blinded to patients' diabetic status. Films with any discordant reading were read by a third reader.


RESULTS
1209 culture positive pulmonary TB patients (581 with DM and 628 without DM) were enrolled. Compared with those without DM, TB patients with DM were significantly more likely to have opacity over lower lung fields, extensive parenchymal lesions, any cavity, multiple cavities and large cavities (>3 cm). The relative risk of lower lung field opacities was 0.80 (95% CI 0.46-1.42) for those with DM with A1C<7%, 2.32 (95% CI 1.36 - 3.98) for A1C 7%-9%, and 1.62 (95% CI 1.12-2.36) for A1C>9%; and that of any cavity over no cavity was 0.87 (95% CI 0.46-1.62) for patients with DM with A1C<7%, 1.84 (95% CI 1.20-2.84) for A1C 7%-9%, and 3.71 (95% CI 2.64-5.22) for A1C>9%, relative to patients without DM.


CONCLUSIONS
Glycemic control significantly influenced radiographic manifestations of pulmonary TB in patients with DM.
International Union Against Tuberculosis and Lung Disease, Paris, France; Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Chen-Yuan
CY
Chiang
Department of Internal Medicine, Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
Jen-Jyh
JJ
Lee
Chest Hospital, Department of Health and Welfare, Tainan County, Taiwan.
Shun-Tien
ST
Chien
International Union Against Tuberculosis and Lung Disease, Paris, France.
Donald A
DA
Enarson
Chest Hospital, Department of Health and Welfare, Tainan County, Taiwan.
You-Cheng
YC
Chang
Department of Internal Medicine, Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
Yi-Ting
YT
Chen
Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Ting-Yu
TY
Hu
Department of Internal Medicine, Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
Chih-Bin
CB
Lin
Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Chi-Won
CW
Suk
Chest Hospital, Department of Health and Welfare, Tainan County, Taiwan.
Jui-Ming
JM
Tao
Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Kuan-Jen
KJ
Bai
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003920:Diabetes Mellitus / Q000000981:diagnostic imaging* / Q000378:metabolism*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D038321:Glycemic Index / Q000502:physiology*; D006801:Humans; D008168:Lung / Q000000981:diagnostic imaging / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011859:Radiography; D014397:Tuberculosis, Pulmonary / Q000000981:diagnostic imaging* / Q000378:metabolism*
D001786:Blood Glucose; D006442:Glycated Hemoglobin