title: Transient Hyperglycemia in Patients With Tuberculosis in Tanzania: Implications for Diabetes Screening Algorithms.
abstract: BACKGROUND
  Diabetes mellitus (DM) increases tuberculosis risk while tuberculosis, as an infectious disease, leads to hyperglycemia. We compared hyperglycemia screening strategies in controls and patients with tuberculosis in Dar es Salaam, Tanzania.
  
  
  METHODS
  Consecutive adults with tuberculosis and sex- and age-matched volunteers were included in a case-control study between July 2012 and June 2014. All underwent DM screening tests (fasting capillary glucose [FCG] level, 2-hour CG [2-hCG] level, and glycated hemoglobin A1c [HbA1c] level) at enrollment, and cases were tested again after receipt of tuberculosis treatment. Association of tuberculosis and its outcome with hyperglycemia was assessed using logistic regression analysis adjusted for sex, age, body mass index, human immunodeficiency virus infection status, and socioeconomic status. Patients with tuberculosis and newly diagnosed DM were not treated for hyperglycemia.
  
  
  RESULTS
  At enrollment, DM prevalence was significantly higher among patients with tuberculosis (n = 539; FCG level > 7 mmol/L, 4.5% of patients, 2-hCG level > 11 mmol/L, 6.8%; and HbA1c level > 6.5%, 9.3%), compared with controls (n = 496; 1.2%, 3.1%, and 2.2%, respectively). The association between hyperglycemia and tuberculosis disappeared after tuberculosis treatment (adjusted odds ratio [aOR] for the FCG level: 9.6 [95% confidence interval {CI}, 3.7-24.7] at enrollment vs 2.4 [95% CI, .7-8.7] at follow-up; aOR for the 2-hCG level: 6.6 [95% CI, 4.0-11.1] vs 1.6 [95% CI, .8-2.9]; and aOR for the HbA1c level, 4.2 [95% CI, 2.9-6.0] vs 1.4 [95% CI, .9-2.0]). Hyperglycemia, based on the FCG level, at enrollment was associated with tuberculosis treatment failure or death (aOR, 3.3; 95% CI, 1.2-9.3).
  
  
  CONCLUSIONS
  Transient hyperglycemia is frequent during tuberculosis, and DM needs confirmation after tuberculosis treatment. Performance of DM screening at tuberculosis diagnosis gives the opportunity to detect patients at risk of adverse outcome.
authors.affiliation: Ifakara Health Institute Swiss Tropical and Public Health Institute Department of Sciences, University of Basel Infectious Diseases Service.
authors.forename: Noémie
authors.initials: N
authors.lastname: Boillat-Blanco
authors.affiliation: Shree Hindu Mandal Hospital Muhimbili University of Health Sciences.
authors.forename: Kaushik L
authors.initials: KL
authors.lastname: Ramaiya
authors.affiliation: Kinondoni Municipal Council, National Tuberculosis Program, Dar es Salaam, United Republic of Tanzania.
authors.forename: Maliwasa
authors.initials: M
authors.lastname: Mganga
authors.affiliation: Ifakara Health Institute.
authors.forename: Lilian T
authors.initials: LT
authors.lastname: Minja
authors.affiliation: Institute of Social and Preventive Medicine, Lausanne University Hospital.
authors.forename: Pascal
authors.initials: P
authors.lastname: Bovet
authors.affiliation: Swiss Tropical and Public Health Institute Department of Sciences, University of Basel.
authors.forename: Christian
authors.initials: C
authors.lastname: Schindler
authors.affiliation: Institute of Clinical Chemistry, University of Zurich, University Hospital of Zurich, Switzerland.
authors.forename: Arnold
authors.initials: A
authors.lastname: Von Eckardstein
authors.affiliation: Swiss Tropical and Public Health Institute Department of Sciences, University of Basel.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gagneux
authors.affiliation: Swiss Tropical and Public Health Institute Department of Sciences, University of Basel.
authors.forename: Claudia
authors.initials: C
authors.lastname: Daubenberger
authors.affiliation: Ifakara Health Institute Swiss Tropical and Public Health Institute Department of Sciences, University of Basel.
authors.forename: Klaus
authors.initials: K
authors.lastname: Reither
authors.affiliation: Swiss Tropical and Public Health Institute Department of Sciences, University of Basel.
authors.forename: Nicole
authors.initials: N
authors.lastname: Probst-Hensch
mesh_terms: D000328:Adult; D000465:Algorithms; D000995:Antitubercular Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D013636:Tanzania / Q000453:epidemiology; D013997:Time Factors; D014397:Tuberculosis, Pulmonary / Q000097:blood* / Q000150:complications* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents; D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: diabetes mellitus; stress-induced hyperglycemia; sub-Saharan Africa; transient hyperglycemia; tuberculosis