title: The effect of diabetes control status on treatment response in pulmonary tuberculosis: a prospective study.
abstract: Uncontrolled diabetes, unlike controlled diabetes, is associated with an impaired immune response. However, little is known about the impact of the status of diabetes control on clinical features and treatment outcomes in patients with pulmonary TB (PTB). We conducted this study to evaluate whether the status of diabetes control influences clinical manifestations and treatment responses in PTB.
  
  
  
  A multicentre prospective study was performed between September 2012 and September 2014. The patients were categorised into three groups according to the glycated haemoglobin (HbA1C) level: PTB without diabetes mellitus (non-DM), PTB with controlled diabetes (controlled-DM) and PTB with uncontrolled diabetes (uncontrolled-DM). The primary outcome was the sputum culture conversion rate after 2 months of intensive treatment.
  
  
  
  Among 661 patients with PTB, 157 (23.8%) had diabetes and 108 (68.8%) had uncontrolled diabetes (HbA1C≥7.0%). The uncontrolled-DM group exhibited more symptoms, positive sputum smears (p<0.001) and presence of cavities (p<0.001) than the non-DM group. Regarding treatment responses, patients with uncontrolled-DM were more likely to have a positive culture after 2 months (p=0.009) and either treatment failure (p=0.015) or death (p=0.027) compared with the non-DM group. In contrast, those with controlled-DM showed similar treatment responses to the non-DM group. In multivariable analysis, uncontrolled diabetes was an independent risk factor for a positive sputum culture after 2 months of treatment (adjusted OR, 2.11; p=0.042) and either treatment failure or death (adjusted OR, 4.11; p=0.022).
  
  
  
  Uncontrolled diabetes is an independent risk factor for poor treatment response in PTB.
authors.affiliation: Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, South Korea.
authors.forename: Young Soon
authors.initials: YS
authors.lastname: Yoon
authors.affiliation: Division of Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University, School of Medicine, Seoul, South Korea.
authors.forename: Jae-Woo
authors.initials: JW
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Hallym Hospital, Incheon, South Korea.
authors.forename: Eun Ju
authors.initials: EJ
authors.lastname: Jeon
authors.affiliation: Department of Tuberculosis, Seobuk Hospital, Seoul Metropolitan Government, Seoul, South Korea.
authors.forename: Haesook
authors.initials: H
authors.lastname: Seo
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University, School of Medicine, Seoul, South Korea.
authors.forename: Yon Ju
authors.initials: YJ
authors.lastname: Ryu
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
authors.forename: Jae-Joon
authors.initials: JJ
authors.lastname: Yim
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea.
authors.forename: Yee Hyung
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Pulmonology and Allergy, Eulji Hospital, College of Medicine, Eulji University, Seoul, South Korea.
authors.forename: Byoung-Hoon
authors.initials: BH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Hallym University Medical Center, Kangdong Sacred Heart Hospital, Seoul, South Korea.
authors.forename: Yong Bum
authors.initials: YB
authors.lastname: Park
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul, South Korea.
authors.forename: Byoung Jun
authors.initials: BJ
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chung-Ang University, School of Medicine, Seoul, South Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Kang
authors.affiliation: Division of Pulmonary Medicine, Department of Internal Medicine, Chung-Ang University, School of Medicine, Seoul, South Korea.
authors.forename: Jae Chol
authors.initials: JC
authors.lastname: Choi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D056910:Republic of Korea; D012307:Risk Factors; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents
keywords: Tuberculosis