title: The influence of diabetes, glycemic control, and diabetes-related comorbidities on pulmonary tuberculosis.
abstract: BACKGROUND
  To assess the influence of diabetes mellitus (DM), glycemic control, and diabetes-related comorbidities on manifestations and outcome of treatment of pulmonary tuberculosis (TB).
  
  
  RESULTS
  Culture positive pulmonary TB patients notified to health authorities in three hospitals in Taiwan from 2005-2010 were investigated. Glycemic control was assessed by glycated haemoglobin A1C (HbA1C) and diabetic patients were categorized into 3 groups: HbA1C<7%, HbA1C 7-9%, HbA1C>9%. 1,473 (705 with DM and 768 without DM) patients were enrolled. Of the 705 diabetic patients, 82 (11.6%) had pretreatment HbA1C<7%, 152 (21.6%) 7%-9%, 276 (39.2%) >9%, and 195 (27.7%) had no information of HbA1C. The proportions of patients with any symptom, cough, hemoptysis, tiredness and weight loss were all highest in diabetic patients with HbA1C>9%. In multivariate analysis adjusted for age, sex, smoking, and drug resistance, diabetic patients with HbA1C>9% (adjOR 3.55, 95% CI 2.40-5.25) and HbA1C 7-9% (adjOR 1.62, 95% CI 1.07-2.44) were significantly more likely to be smear positive as compared with non-diabetic patients, but not those with HbA1C<7% (adjOR 1.16, 95% CI 0.70-1.92). The influence of DM on outcome of TB treatment was not proportionately related to HbA1C, but mainly mediated through diabetes-related comorbidities. Patients with diabetes-related comorbidities had an increased risk of unfavorable outcome (adjOR 3.38, 95% CI 2.19-5.22, p<0.001) and one year mortality (adjOR 2.80, 95% CI 1.89-4.16). However, diabetes was not associated with amplification of resistance to isoniazid (p = 0.363) or to rifampicin (p = 0.344).
  
  
  CONCLUSIONS
  Poor glycemic control is associated with poor TB treatment outcome and improved glycemic control may reduce the influence of diabetes on TB.
authors.affiliation: 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.
authors.forename: Chen Yuan
authors.initials: CY
authors.lastname: Chiang
authors.affiliation: 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.
authors.forename: Kuan Jen
authors.initials: KJ
authors.lastname: Bai
authors.affiliation: Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: Hsien Ho
authors.initials: HH
authors.lastname: Lin
authors.affiliation: Chest Hospital, Department of Health, Tainan County, Taiwan.
authors.forename: Shun Tien
authors.initials: ST
authors.lastname: Chien
authors.affiliation: Department of Internal Medicine, Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: Jen Jyh
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Enarson
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Ting-I
authors.initials: TI
authors.lastname: Lee
authors.affiliation: 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.
authors.forename: Ming-Chih
authors.initials: MC
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D015897:Comorbidity; D048909:Diabetes Complications / Q000097:blood* / Q000453:epidemiology / Q000628:therapy; D003920:Diabetes Mellitus / Q000097:blood* / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
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