title: Diabetes mellitus, smoking status, and rate of sputum culture conversion in patients with multidrug-resistant tuberculosis: a cohort study from the country of Georgia.
abstract: BACKGROUND
  Diabetes mellitus (DM) is a risk factor for active tuberculosis (TB) but little is known about the effect of DM on culture conversion among patients with multidrug-resistant (MDR)-TB. The primary aim was to estimate the association between DM and rate of TB sputum culture conversion. A secondary objective was to estimate the association between DM and the risk of poor treatment outcomes among patients with MDR-TB.
  
  
  METHODS
  A cohort of all adult patients starting MDR-TB treatment in the country of Georgia between 2009-2011 was followed during second-line TB therapy. Cox proportional models were used to estimate the adjusted hazard rate of sputum culture conversion. Log-binomial regression models were used to estimate the cumulative risk of poor TB treatment outcome.
  
  
  RESULTS
  Among 1,366 patients with sputum culture conversion information, 966 (70.7%) had culture conversion and the median time to conversion was 68 days (interquartile range 50-120). The rate of conversion was similar among patients with MDR-TB and DM (adjusted hazard ratio [aHR] 0.95, 95%CI 0.71-1.28) compared to patients with MDR-TB only. The rate of culture conversion was significantly less in patients that currently smoked (aHR 0.82, 95%CI 0.71-0.95), had low body mass index (aHR 0.71, 95%CI 0.59-0.84), second-line resistance (aHR 0.56, 95%CI 0.43-0.73), lung cavities (aHR 0.70, 95%CI 0.59-0.83) and with disseminated TB (aHR 0.75, 95%CI 0.62-0.90). The cumulative risk of poor treatment outcome was also similar among TB patients with and without DM (adjusted risk ratio [aRR] 1.03, 95%CI 0.93-1.14).
  
  
  CONCLUSIONS
  In adjusted analyses, DM did not impact culture conversion rates in a clinically meaningful way but smoking did.
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Magee
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: Russell R
authors.initials: RR
authors.lastname: Kempker
authors.affiliation: National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
authors.forename: Maia
authors.initials: M
authors.lastname: Kipiani
authors.affiliation: National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
authors.forename: Nestani
authors.initials: N
authors.lastname: Tukvadze
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: Penelope P
authors.initials: PP
authors.lastname: Howards
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America; Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: Henry M
authors.initials: HM
authors.lastname: Blumberg
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003920:Diabetes Mellitus; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking; D013183:Sputum / Q000382:microbiology*; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
references.citation: Int J Tuberc Lung Dis. 2006 Apr;10(4):396-401
references.pmid: 16602403
references.citation: Lancet Infect Dis. 2009 Dec;9(12):737-46
references.pmid: 19926034
references.citation: Epidemiology. 1999 Jan;10(1):37-48
references.pmid: 9888278
references.citation: Trop Doct. 2008 Apr;38(2):91-3
references.pmid: 18453496
references.citation: Int J Epidemiol. 2011 Apr;40(2):428-31
references.pmid: 21252211
references.citation: Scand J Infect Dis. 2008;40(11-12):888-93
references.pmid: 18728934
references.citation: Int J Tuberc Lung Dis. 2013 Feb;17(2):225-8
references.pmid: 23317958
references.citation: Int J Tuberc Lung Dis. 2011 Nov;15(11):1436-44, i
references.pmid: 21902876
references.citation: PLoS Med. 2008 Jul 15;5(7):e152
references.pmid: 18630984
references.citation: Lancet. 2010 May 22;375(9728):1830-43
references.pmid: 20488523
references.citation: Chronic Illn. 2007 Sep;3(3):228-45
references.pmid: 18083679
references.citation: Diabetes Res Clin Pract. 2013 Jul;101(1):10-9
references.pmid: 23305899
references.citation: Int J Tuberc Lung Dis. 2011 Nov;15(11):1556-9, i
references.pmid: 22008773
references.citation: Int J Tuberc Lung Dis. 2011 Jun;15(6):838-43
references.pmid: 21575308
references.citation: J Infect Dis. 2011 May 1;203(9):1240-8
references.pmid: 21357942
references.citation: Pharmacoeconomics. 2012 Jan;30(1):63-80
references.pmid: 22070215
references.citation: Tuberculosis (Edinb). 2012 Sep;92(5):397-403
references.pmid: 22789497
references.citation: Thorax. 2013 Mar;68(3):214-20
references.pmid: 23250998
references.citation: Am J Trop Med Hyg. 2008 Oct;79(4):541-4
references.pmid: 18840741
references.citation: Respirology. 2013 May;18(4):596-604
references.pmid: 23551328
references.citation: Trop Med Int Health. 2010 Jun;15(6):659-63
references.pmid: 20406430
references.citation: PLoS One. 2012;7(2):e31563
references.pmid: 22347495
references.citation: Int J Tuberc Lung Dis. 2012 Oct;16(10):1335-43
references.pmid: 23107633
references.citation: PLoS One. 2009 Sep 09;4(9):e6914
references.pmid: 19742330
references.citation: Ann Intern Med. 2006 May 2;144(9):650-9
references.pmid: 16670134
references.citation: BMC Med. 2011 Jul 01;9:81
references.pmid: 21722362