Early interventions for diabetes related tuberculosis associate with hastened sputum microbiological clearance in Virginia, USA.
Diabetes complicates tuberculosis (TB) treatment including a prolonged time of sputum culture conversion to negative growth. Since 2013 in Virginia, interventions early in the treatment course have used therapeutic drug monitoring and dose correction for isoniazid and rifampin after 2 weeks of TB treatment in patients with diabetes along with nurse manager initiated diabetes education and linkage to care.



A retrospective cohort study of the state TB registry was performed for patients initiating drug-susceptible pulmonary TB treatment that were matched for age, gender, chest imaging and sputum smear status to compare time to sputum culture conversion and other clinical outcomes in the pre-and post-intervention groups.



Three hundred sixty-three patients had documented time to sputum culture conversion in the pre-and post-intervention periods, including 56 (15%) with diabetes. Seventy-four (57%) of all patients with diabetes were ≥60 years of age at treatment initiation. Twenty-six patients with diabetes were matched in each group. Mean time to sputum culture conversion in the post-intervention group was 42 ± 22 days compared to the pre-intervention group of 62 ± 31 days (p = 0.01). In the post-intervention group 21 (80%) of patients with diabetes had culture conversion by 2 months compared to 13 (50%) in the pre-intervention group (p = 0.04).



Early interventions for diabetes related TB in the programmatic setting may hasten sputum culture conversion.
Division of Infectious Diseases and International Health, University of Virginia School of Medicine, P.O. Box 801340, Charlottesville, VA, 22908, USA. yma9f@virginia.edu.
Yosra
0000-0002-7743-9172
Y
Alkabab
Division of Disease Prevention, TB Control, Virginia Department of Health, 109 Governor Street, Richmond, VA, 23219, USA.
Suzanne
S
Keller
TB Control and Newcomer Health, Virginia Department of Health, PO Box 2448, 109 Governor Street, Room 326, Richmond, VA, 23218, USA.
Denise
D
Dodge
Division of Infectious Diseases and International Health, University of Virginia School of Medicine, P.O. Box 801340, Charlottesville, VA, 22908, USA.
Eric
E
Houpt
TB Control and Newcomer Health, Virginia Department of Health, PO Box 2448, 109 Governor Street, Room 326, Richmond, VA, 23218, USA.
Deborah
D
Staley
Division of Infectious Diseases and International Health, University of Virginia School of Medicine, P.O. Box 801340, Charlottesville, VA, 22908, USA.
Scott
S
Heysell
D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D048909:Diabetes Complications; D016903:Drug Monitoring; D018479:Early Intervention, Educational; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000187:drug effects / Q000302:isolation & purification; D012189:Retrospective Studies; D013183:Sputum / Q000382:microbiology*; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy*; D014768:Virginia
D000995:Antitubercular Agents
Clinical outcomes; Diabetes; Early intervention; Sputum culture conversion; Therapeutic drug monitoring; Tuberculosis