title: Effects of diabetes mellitus on the clinical presentation and treatment response in tuberculosis.
abstract: With the colliding global epidemics of diabetes mellitus (DM) and tuberculosis (TB), we studied the effects of DM on the presentation of TB and its response to treatment.
  
  
  
  Consecutive TB patients from 2006 to 2010 in a territory-wide treatment programme offering 9-month extended treatment for TB patients with DM were examined and followed up prospectively to assess their treatment response. Successful treatment completers were tracked through the TB registry and death registry for relapse, death or till 31 December 2014, whichever was the earliest.
  
  
  
  DM was independently associated with more chest symptoms (adjusted OR (AOR): 1.13) and systemic symptoms (AOR: 1.30) but less with other site-specific symptoms (AOR: 0.58) at TB presentation. There was more frequent pulmonary involvement (AOR: 1.69), with more extensive lung lesion (AOR: 1.25), lung cavity (AOR: 2.00) and positive sputum smear (AOR: 1.83) and culture (AOR: 1.38), but no difference in the proportion of retreatment cases or isoniazid and/or rifampicin resistance. After treatment initiation, there was higher overall incidence (AOR: 1.38) of adverse effects (mainly gastrointestinal symptoms, renal impairment and peripheral neuropathy but less fever and skin hypersensitivity reactions), more smear non-conversion (AOR: 1.59) and culture non-conversion (AOR: 1.40) at 2 months, and lower combined cure/treatment completion rate at 12 months (AOR: 0.79), but no difference in the relapse rate after having successfully completed treatment.
  
  
  
  DM adversely affected the clinical presentation and treatment response of TB, but there was no difference in the drug resistance and relapse rates.
authors.affiliation: Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong, China.
authors.forename: Chi C
authors.identifier: 0000-0002-9699-9730
authors.initials: CC
authors.lastname: Leung
authors.affiliation: Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Wing W
authors.initials: WW
authors.lastname: Yew
authors.affiliation: Respiratory Medical Department, Kowloon Hospital, Hong Kong, China.
authors.forename: Thomas Y W
authors.initials: TYW
authors.lastname: Mok
authors.affiliation: Respiratory Medical Unit, Ruttonjee Hospital, Hong Kong, China.
authors.forename: Kam S
authors.initials: KS
authors.lastname: Lau
authors.affiliation: Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong, China.
authors.forename: Chi F
authors.initials: CF
authors.lastname: Wong
authors.affiliation: Tuberculosis and Chest Unit, Grantham Hospital, Hong Kong, China.
authors.forename: Chi H
authors.initials: CH
authors.lastname: Chau
authors.affiliation: Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong, China.
authors.forename: Chi K
authors.initials: CK
authors.lastname: Chan
authors.affiliation: Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong, China.
authors.forename: Kwok C
authors.initials: KC
authors.lastname: Chang
authors.affiliation: Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Greta
authors.initials: G
authors.lastname: Tam
authors.affiliation: Department of Health, Tuberculosis and Chest Service, Centre for Health Protection, Hong Kong, China.
authors.forename: Cheuk M
authors.initials: CM
authors.lastname: Tam
mesh_terms: D000328:Adult; D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D048909:Diabetes Complications / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000175:diagnosis* / Q000628:therapy*; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents
keywords: diabetes mellitus; drug resistance; outcomes; presentation; tuberculosis