title: Comparison of bacteriological conversion and treatment outcomes among MDR-TB patients with and without diabetes in Mexico: Preliminary data.
abstract: Diabetes mellitus (DM) is a well-known risk factor for tuberculosis (TB). However, it is not known to what extent DM affects the outcome in patients with multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB) treated with second-line anti-TB drugs. The objective of this study was to compare the microbiological evolution (sputum smear and culture conversion) and final outcomes of MDR/XDR-TB patients with and without DM, managed at the national TB reference centre in Mexico City.
  
  
  RESULTS
  Ninety patients were enrolled between 2010 and 2015: 73 with MDR-TB (81.1%), 11 with pre-XDR-TB (e.g. MDR-TB with additional resistance to one injectable drug or a fluoroquinolone, 12.2%) and 6 (6.7%) with XDR-TB. Out of these, 49 (54.4%) had DM and 42 (86%) were undergoing insulin treatment. No statistically significant differences were found in treatment outcomes comparing DM vs. non-DM MDR-TB cases: 18/32 (56.3%) of DM cases and 19/24 (79.2%) non DM patients achieved treatment success (p=0.07). The time to sputum smear and culture conversion was longer (although not statistically) in patients without DM, as follows: the mean (±SD) time to sputum smear conversion was 53.9 (±31.4) days in DM patients and 65.2 (±34.8) days in non-DM ones (p=0.15), while the time to culture conversion was 66.2 (±27.6) days for DM and 81.4 (±37.7) days for non-DM MDR-TB cases (p=0.06).
  
  
  CONCLUSIONS
  The study results support the Mexican National TB programme to strengthen its collaboration with the DM programme, as an entry point for TB (and latent TB infection) screening and management.
authors.affiliation: Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
authors.forename: M
authors.initials: M
authors.lastname: Muñoz-Torrico
authors.affiliation: Pneumology Department, University Hospital of Gran Canaria "Dr. Negrin", Las Palmas, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Caminero Luna
authors.affiliation: WHO Collaborating Centre for TB and Lug Diseases, Maugeri Institute, IRCCS Tradate, Italy. Electronic address: giovannibattista.migliori@fsm.it.
authors.forename: G B
authors.initials: GB
authors.lastname: Migliori
authors.affiliation: WHO Collaborating Centre for TB and Lug Diseases, Maugeri Institute, IRCCS Tradate, Italy; Public Health Consulting Group, Lugano, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: D'Ambrosio
authors.affiliation: Sleep Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
authors.forename: J L
authors.initials: JL
authors.lastname: Carrillo-Alduenda
authors.affiliation: Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
authors.forename: H
authors.initials: H
authors.lastname: Villareal-Velarde
authors.affiliation: Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
authors.forename: A
authors.initials: A
authors.lastname: Torres-Cruz
authors.affiliation: Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
authors.forename: H
authors.initials: H
authors.lastname: Flores-Ergara
authors.affiliation: Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
authors.forename: D
authors.initials: D
authors.lastname: Martínez-Mendoza
authors.affiliation: Department of Epidemiology, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
authors.forename: C
authors.initials: C
authors.lastname: García-Sancho
authors.affiliation: WHO Collaborating Centre for TB and Lug Diseases, Maugeri Institute, IRCCS Tradate, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Centis
authors.affiliation: Tuberculosis Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
authors.forename: M Á
authors.initials: MÁ
authors.lastname: Salazar-Lezama
authors.affiliation: Sleep Clinic, National Institute of Respiratory Diseases of Mexico (INER), Mexico City, Mexico.
authors.forename: R
authors.initials: R
authors.lastname: Pérez-Padilla
mesh_terms: D000995:Antitubercular Agents / Q000494:pharmacology* / Q000627:therapeutic use*; D048909:Diabetes Complications / Q000188:drug therapy / Q000382:microbiology*; D054908:Extensively Drug-Resistant Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008800:Mexico; D009169:Mycobacterium tuberculosis / Q000187:drug effects* / Q000302:isolation & purification; D013183:Sputum / Q000382:microbiology; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology*
chemical_list: D000995:Antitubercular Agents
keywords: Delay; Diabetes mellitus; High treatment adherence; MDR-TB; Sputum and culture conversion