Glycemic control during TB treatment among Filipinos [TB0101]

-

·  High TB Incidence in the Philippines: The Philippines has one of the highest TB incidences globally (539/100,000).

·  Diabetes Prevalence: In 2020, 6.5% of Filipino adults were estimated to have diabetes mellitus (DM), as reported by the International Diabetes Federation.

·  Impact of Poor Glycemic Control: Poor long-term glycemic control, measured by HbA1c, is associated with an increased risk of TB, severe clinical presentations, and poor TB treatment outcomes.

·  Factors Affecting Glycemic Control: Individual health status, disease management practices, and the health system all influence glycemic control in DM patients.

·  Central Obesity as a Diabetes Risk Factor: Central obesity, common in Asian populations, predicts diabetes and is associated with hyperglycemia and poor glycemic control at TB treatment onset, which can negatively impact TB outcomes.

·  TB and Transient Hyperglycemia: TB-related inflammation and insulin resistance may cause transient hyperglycemia, resolving with effective TB treatment and potentially confounding earlier study findings.

·  Glycemic Control Over DM Presence: The degree of glycemic control may be more critical to TB outcomes than simply having or not having DM.

·  DM Diagnosis Timing and Blood Glucose Control: Patients diagnosed with DM before starting TB treatment are more likely to have uncontrolled blood glucose levels during treatment than those diagnosed with DM at treatment start.

·  Transient Hyperglycemia and Overdiagnosis Risk: One-third of those initially identified as new DM cases may have only transient hyperglycemia, suggesting that DM screening in TB programs should confirm diagnoses outside the acute treatment phase.

·  Central Obesity and HbA1c Levels: Among DM patients, those without central obesity had higher HbA1c levels than centrally obese individuals if diagnosed before TB treatment. Conversely, those diagnosed at treatment start had higher HbA1c levels if centrally obese.

·  DM and TB Advanced Disease Stage: For TB-DM patients without central obesity, higher HbA1c levels may indicate advanced disease and metabolic disruption. This could reflect severe disease stages in TB or both TB and DM.

·  Research and Multi-site Collaboration: Exclusions of patients with fewer HbA1c results and small outcome categories may introduce bias in studies. Future studies require larger sample sizes (over 1,000 TB-DM patients) to assess the impact of poor glycemic control on TB outcomes, likely necessitating multi-site collaboration.

Source: Oliveira Hashiguchi, L., Ferrer, J.P., Suzuki, S., Faguer, B.N., Solon, J.A., Castro, M.C., et al. (2024). Glycemic control during TB treatment among Filipinos: The Starting Anti-Tuberculosis Treatment Cohort Study. PLOS Global Public Health, 4(5), e0003156. 

 

Comments

Post a Comment

Popular posts from this blog

Health status and treatment outcome of TB with DM cases, Gujarat [TB0104]

-
The world is undergoing an epidemiological transition in disease burden, with a gradual decline in deaths from communicable diseases (CDs) and a steady rise in non-communicable diseases (NCDs). This shift has intensified competition for policy attention and resources between advocates for CDs, such as tuberculosis (TB), and those focused on NCDs, like cardiovascular diseases and diabetes mellitus (DM). The global increase in type 2 DM has emerged as a substantial challenge for TB control, as today more TB patients are living with diabetes than with concomitant human immunodeficiency virus (HIV) infection. Thus, the association between DM and TB may become the next significant challenge for global TB control. The bidirectional relationship between TB and DM is well-documented. Diabetes is an independent risk factor for TB development, while TB can also lead to impaired glucose tolerance (IGT) and new-onset diabetes. Additionally, diabetes may alter TB symptoms, radiological findings, ...
Read more

The potential association between metabolic disorders and pulmonary TB [TB0109]

-
Mendelian randomization (MR) is a scientific approach used to assess causal relationships between modifiable risk factors and clinically relevant outcomes by utilizing genetic variants as instrumental variables in natural experiments. This method, which relies on genome-wide association studies (GWAS) data, provides valuable insights into potential causal connections, enabling researchers to make informed decisions regarding preventive measures and therapeutic interventions. Randomized controlled trials (RCTs) remain the gold standard for establishing causality. However, when clinical research is too costly, impractical, or unethical, MR has become a compelling alternative. Compared to traditional observational studies, MR is less susceptible to confounding factors and reverse causality since it focuses on genetic components rather than environmental ones. In this study, the causal relationships between metabolic factors and pulmonary tuberculosis (PTB) were examined through two-sample...
Read more

The definition of tuberculosis infection based on the spectrum of TB disease [TB0112]

-
Tuberculosis (TB) is an airborne disease transmitted by inhaling droplet nuclei, ranging from 1 to 5 µm, released when contagious individuals cough, speak, sing, or sneeze. After exposure to Mycobacterium tuberculosis (Mtb), around 20–25% of individuals become infected. Of these, 5–10% may develop active TB within the first five years. In the remaining 90%, the immune system—via innate and adaptive responses—controls the pathogen's replication. About 10% of infected individuals may develop active TB at some point in their lifetime. The risk is significantly higher for those co-infected with HIV, with a 10% annual risk and up to a 50% lifetime risk of developing active TB. The term "latent tuberculosis infection" (LTBI) refers to a state of persistent immune response to Mtb antigens, as detected by tests like the tuberculin skin test (TST) or interferon-gamma (IFN-γ) release assay (IGRA), without clinical signs of active TB. Historically, a dualistic approach—classifying ...
Read more