title: Diabetes Reduces the Rate of Sputum Culture Conversion in Patients With Newly Diagnosed Multidrug-Resistant Tuberculosis.
abstract: Background.  Diabetes is a risk factor for active tuberculosis (TB), but little is known about the relationship between diabetes and multidrug-resistant (MDR) TB. We aimed to assess risk factors for primary MDR TB, including diabetes, and determine whether diabetes reduced the rate of sputum culture conversion among patients with MDR TB. Methods.  From 2011 to 2014, we conducted a cohort study at the National Center for Tuberculosis and Lung Diseases in Tbilisi, Georgia. Adult (≥35 years) patients with primary TB were eligible. Multidrug-resistant TB was defined as resistance to at least rifampicin and isoniazid. Patients with capillary glycosylated hemoglobin (HbA1c) ≥ 6.5% or previous diagnosis were defined to have diabetes. Polytomous regression was used to estimate the association of patient characteristics with drug resistance. Cox regression was used to compare rates of sputum culture conversion in patients with and without diabetes. Results.  Among 318 patients with TB, 268 had drug-susceptibility test (DST) results. Among patients with DST results, 19.4% (52 of 268) had primary MDR TB and 13.4% (36 of 268) had diabetes. In multivariable analyses, diabetes (adjusted odds ratio [aOR], 2.51; 95% confidence interval [CI], 1.00-6.31) and lower socioeconomic status (aOR, 3.51; 95% CI, 1.56-8.20) were associated with primary MDR TB. Among patients with primary MDR TB, 44 (84.6%) converted sputum cultures to negative. The rate of sputum culture conversion was lower among patients with diabetes (adjusted hazard ratio [aHR], 0.34; 95% CI, .13-.87) and among smokers (aHR, 0.16; 95% CI, .04-.61). Conclusions.  We found diabetes was associated with an increased risk of primary MDR TB; both diabetes and smoking were associated with a longer time to sputum culture conversion.
authors.affiliation: Division of Epidemiology and Biostatistics , School of Public Health, Georgia State University.
authors.forename: Argita D
authors.initials: AD
authors.lastname: Salindri
authors.affiliation: National Center for Tuberculosis and Lung Disease, Tbilisi, Country of Georgia.
authors.forename: Maia
authors.initials: M
authors.lastname: Kipiani
authors.affiliation: Division of Infectious Diseases, Department of Medicine , Emory University School of Medicine.
authors.forename: Russell R
authors.initials: RR
authors.lastname: Kempker
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Neel R
authors.initials: NR
authors.lastname: Gandhi
authors.affiliation: National Center for Tuberculosis and Lung Disease, Tbilisi, Country of Georgia.
authors.forename: Lasha
authors.initials: L
authors.lastname: Darchia
authors.affiliation: National Center for Tuberculosis and Lung Disease, Tbilisi, Country of Georgia.
authors.forename: Nestani
authors.initials: N
authors.lastname: Tukvadze
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine; Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Henry M
authors.initials: HM
authors.lastname: Blumberg
authors.affiliation: Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University; Departments of Epidemiology and Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Magee
keywords: Georgia; MDR TB; culture conversion; diabetes; socioeconomic status