title: Diabetes is Associated with Severe Adverse Events in Multidrug-Resistant Tuberculosis.
abstract: BACKGROUND
  Diabetes mellitus (DM), a very common disease in Mexico, is a well-known risk factor for tuberculosis (TB). However, it is not known by which extent DM predisposes to adverse events (AE) to anti-TB drugs and/or to worse outcomes in patients with multidrug-resistant (MDR-TB) and extensively drug-resistant TB (XDR-TB). The main objective of this study was to describe the outcomes of TB treatment, the impact of DM and the prevalence of AE in a cohort of patients with MDR-/XDR pulmonary TB treated at the national TB referral centre in Mexico City.
  
  
  RESULTS
  Ninety patients were enrolled between 2010 and 2015: 73 with MDR-TB (81.1%), 11 with pre-XDR-TB (12.2%) and 6 (6.7%) with XDR-TB, including 49 (54.4%) with DM, and 3 with Human Immunodeficiency Virus (HIV) co-infection (3.3%). In 98% of patients, diagnosis was made by culture and drug susceptibility testing, while in a single case the diagnosis was made by a molecular test. The presence of DM was associated with an increased risk of serious drug-related AEs, such as nephrotoxicity (Odds Ratio [OR]=6.5; 95% Confidence Interval [95% CI]: 1.9-21.8) and hypothyroidism (OR=8.8; 95% CI: 1.8-54.2), but not for a worse outcome.
  
  
  CONCLUSIONS
  Our data suggest that DM does not impact second-line TB treatment outcomes, but patients with DM have a higher risk of developing serious AEs to drug-resistant TB treatment, such as nephrotoxicity and hypothyroidism.
authors.affiliation: Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias de México (INER), Ciudad de México, México.
authors.forename: Marcela
authors.initials: M
authors.lastname: Muñoz-Torrico
authors.affiliation: Departamento de Neumología, Hospital Universitario de Gran Canaria «Dr. Negrín», Las Palmas, Canarias, España.
authors.forename: José
authors.initials: J
authors.lastname: Caminero-Luna
authors.affiliation: WHO Collaborating Centre for TB and Lung Diseases, Maugeri Institute, IRCCS, Tradate, Italia. Electronic address: giovannibattista.migliori@fsm.it.
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Migliori
authors.affiliation: WHO Collaborating Centre for TB and Lung Diseases, Maugeri Institute, IRCCS, Tradate, Italia; Public Health Consulting Group, Lugano, Suiza.
authors.forename: Lia
authors.initials: L
authors.lastname: D'Ambrosio
authors.affiliation: Clínica del Sueño, Instituto Nacional de Enfermedades Respiratorias de México (INER), Ciudad de México, México.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Carrillo-Alduenda
authors.affiliation: Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias de México (INER), Ciudad de México, México.
authors.forename: Héctor
authors.initials: H
authors.lastname: Villareal-Velarde
authors.affiliation: Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias de México (INER), Ciudad de México, México.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Torres-Cruz
authors.affiliation: Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias de México (INER), Ciudad de México, México.
authors.forename: Héctor
authors.initials: H
authors.lastname: Flores-Vergara
authors.affiliation: Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias de México (INER), Ciudad de México, México.
authors.forename: Dina
authors.initials: D
authors.lastname: Martínez-Mendoza
authors.affiliation: Departamento de Epidemiología, Instituto Nacional de Enfermedades Respiratorias de México (INER), Ciudad de México, México.
authors.forename: Cecilia
authors.initials: C
authors.lastname: García-Sancho
authors.affiliation: WHO Collaborating Centre for TB and Lung Diseases, Maugeri Institute, IRCCS, Tradate, Italia.
authors.forename: Rosella
authors.initials: R
authors.lastname: Centis
authors.affiliation: Clínica de Tuberculosis, Instituto Nacional de Enfermedades Respiratorias de México (INER), Ciudad de México, México.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Salazar-Lezama
authors.affiliation: Clínica del Sueño, Instituto Nacional de Enfermedades Respiratorias de México (INER), Ciudad de México, México.
authors.forename: Rogelio
authors.initials: R
authors.lastname: Pérez-Padilla
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004198:Disease Susceptibility; D054908:Extensively Drug-Resistant Tuberculosis / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D034381:Hearing Loss / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007037:Hypothyroidism / Q000139:chemically induced / Q000453:epidemiology; D007674:Kidney Diseases / Q000139:chemically induced / Q000453:epidemiology; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy* / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: Adverse events; Diabetes mellitus; Mexico; Multidrug-resistant tuberculosis; México; Reacciones adversas; Tuberculosis; Tuberculosis multirresistente