title: Diabetes mellitus is associated with cavities, smear grade, and multidrug-resistant tuberculosis in Georgia.
abstract: METHODS
  National tuberculosis (TB) treatment facility in the country of Georgia.
  
  
  OBJECTIVE
  To determine the prevalence of diabetes mellitus (DM) and pre-DM among patients with TB using glycosylated-hemoglobin (HbA1c), and to estimate the association between DM and clinical characteristics and response to anti-tuberculosis treatment.
  
  
  METHODS
  A cohort study was conducted from 2011 to 2014 at the National Centre for TB and Lung Disease in Tbilisi. Patients aged ⩾ 35 years with pulmonary TB were included. HbA1c was used to define DM (⩾ 6.5%), pre-DM (⩾ 5.7-6.4%), and no DM (<5.7%). Interviews and medical chart abstraction were performed. Regression analyses estimated associations between DM and 1) baseline TB characteristics and 2) anti-tuberculosis treatment outcomes.
  
  
  RESULTS
  A total of 318 newly diagnosed patients with TB were enrolled. The prevalence of DM and pre-DM was 11.6% and 16.4%, respectively. In multivariable analyses, patients with TB-DM had more cavitation (adjusted OR [aOR] 2.26), higher smear grade (aOR 2.37), and more multidrug-resistant TB (MDR-TB) (aOR 2.27) than patients without DM. The risk of poor anti-tuberculosis treatment outcomes was similar among patients with and those without DM (28.1% vs. 23.6%).
  
  
  CONCLUSIONS
  DM and pre-DM were common among adults with newly diagnosed pulmonary TB in Tbilisi, Georgia, and DM was associated with more clinical symptoms, and MDR-TB, at presentation.
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, USA; Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Magee
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: R R
authors.initials: RR
authors.lastname: Kempker
authors.affiliation: National Center for Tuberculosis and Lung Diseases, Tbilisi, Republic of Georgia, USA.
authors.forename: M
authors.initials: M
authors.lastname: Kipiani
authors.affiliation: Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, USA; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: N R
authors.initials: NR
authors.lastname: Gandhi
authors.affiliation: National Center for Tuberculosis and Lung Diseases, Tbilisi, Republic of Georgia, USA.
authors.forename: L
authors.initials: L
authors.lastname: Darchia
authors.affiliation: National Center for Tuberculosis and Lung Diseases, Tbilisi, Republic of Georgia, USA.
authors.forename: N
authors.initials: N
authors.lastname: Tukvadze
authors.affiliation: Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, USA.
authors.forename: P P
authors.initials: PP
authors.lastname: Howards
authors.affiliation: Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, USA.
authors.forename: K M V
authors.initials: KM
authors.lastname: Narayan
authors.affiliation: Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, USA; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Blumberg
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005846:Georgia (Republic) / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D016017:Odds Ratio; D011236:Prediabetic State / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology
chemical_list: D000995:Antitubercular Agents; D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human