High rates of undiagnosed diabetes mellitus among patients with active tuberculosis in Addis Ababa, Ethiopia
Background: Tuberculosis (TB) and diabetes mellitus (DM) have negative synergistic impact on each other. Global guidelines recommend collaborative efforts to address this synergy, but implementation has been slow. Part of the reason is lack of adequate evidence on the operational feasibility of exis...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-05-01
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| Series: | Journal of Clinical Tuberculosis and Other Mycobacterial Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405579422000110 |
| _version_ | 1818242479379447808 |
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| author | Degu Jerene Chaltu Muleta Abdurezak Ahmed Getahun Tarekegn Tewodros Haile Ahmed Bedru Agnes Gebhard Fraser Wares |
| author_facet | Degu Jerene Chaltu Muleta Abdurezak Ahmed Getahun Tarekegn Tewodros Haile Ahmed Bedru Agnes Gebhard Fraser Wares |
| author_sort | Degu Jerene |
| collection | DOAJ |
| description | Background: Tuberculosis (TB) and diabetes mellitus (DM) have negative synergistic impact on each other. Global guidelines recommend collaborative efforts to address this synergy, but implementation has been slow. Part of the reason is lack of adequate evidence on the operational feasibility of existing tools and mechanisms of collaboration. The objective of this study was to assess the yield of DM screening among TB patients using risk scoring tools combined with blood tests as a feasible strategy for early detection to improve TB/DM treatment outcomes. Methods: Between September 2020 and December 2021, we conducted a cross-sectional study among patients receiving TB treatment in public health facilities in Addis Ababa, Ethiopia. Trained health workers collected data on symptoms and risk scoring checklists before testing for random and fasting blood glucose levels. We used logistic regression analyses techniques to determine factors associated with increased DM detection. A receiver-operating characteristic curve was constructed to determine the performance of the risk scoring checklist. Results: Of 2381 TB patients screened, 197 (8.3%) had DM of which 48.7% were newly diagnosed. Having a family history of DM predicted DM with Odds Ratio (OR) of 5.36 (95% Confidence Interval, [3.67, 7.83]) followed by age ≥ 45 years (OR = 4.64, [3.18, 6.76]). Having one or more “symptoms” of DM was a significant predictor (OR 2.88, 95% CI, 2.06–4.01). Combining risk scores with symptoms predicted DM diagnosis with sensitivity of 94.7%, but specificity was low at 29.4%. In patients with known treatment outcome status, death rate was high. Conclusions: Almost a half of TB patients with DM did not know their status. A simple tool that combined risk factors with symptoms accurately predicted a subsequent diagnosis of DM. Such tools can help avoid high rates of death among TB patients suffering from DM through early detection. |
| first_indexed | 2024-12-12T13:45:53Z |
| format | Article |
| id | doaj.art-993ba3c1a51344978895b1da9d71ec57 |
| institution | Directory Open Access Journal |
| issn | 2405-5794 |
| language | English |
| last_indexed | 2024-12-12T13:45:53Z |
| publishDate | 2022-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Clinical Tuberculosis and Other Mycobacterial Diseases |
| spelling | doaj.art-993ba3c1a51344978895b1da9d71ec572022-12-22T00:22:41ZengElsevierJournal of Clinical Tuberculosis and Other Mycobacterial Diseases2405-57942022-05-0127100306High rates of undiagnosed diabetes mellitus among patients with active tuberculosis in Addis Ababa, EthiopiaDegu Jerene0Chaltu Muleta1Abdurezak Ahmed2Getahun Tarekegn3Tewodros Haile4Ahmed Bedru5Agnes Gebhard6Fraser Wares7KNCV Tuberculosis Foundation, Technical Division, The Hague, Netherlands; Corresponding author at: KNCV Tuberculosis Foundation, Maanweg 174, 2516 AB Den Haag, Netherlands.KNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, EthiopiaAddis Ababa University, Black Lion Specialized Hospital, Department of Internal Medicine, Diabetic Clinic, Addis Ababa, EthiopiaAddis Ababa University, Black Lion Specialized Hospital, Department of Internal Medicine, Diabetic Clinic, Addis Ababa, EthiopiaAddis Ababa University, College of Health Sciences and Tikur Anbessa Specialized Hospital, Department of Internal Medicine, Pulmonary and Critical Care Medicine Unit, Addis Ababa, EthiopiaKNCV Tuberculosis Foundation, Ethiopia Country Office, Addis Ababa, EthiopiaKNCV Tuberculosis Foundation, Technical Division, The Hague, NetherlandsKNCV Tuberculosis Foundation, Technical Division, The Hague, NetherlandsBackground: Tuberculosis (TB) and diabetes mellitus (DM) have negative synergistic impact on each other. Global guidelines recommend collaborative efforts to address this synergy, but implementation has been slow. Part of the reason is lack of adequate evidence on the operational feasibility of existing tools and mechanisms of collaboration. The objective of this study was to assess the yield of DM screening among TB patients using risk scoring tools combined with blood tests as a feasible strategy for early detection to improve TB/DM treatment outcomes. Methods: Between September 2020 and December 2021, we conducted a cross-sectional study among patients receiving TB treatment in public health facilities in Addis Ababa, Ethiopia. Trained health workers collected data on symptoms and risk scoring checklists before testing for random and fasting blood glucose levels. We used logistic regression analyses techniques to determine factors associated with increased DM detection. A receiver-operating characteristic curve was constructed to determine the performance of the risk scoring checklist. Results: Of 2381 TB patients screened, 197 (8.3%) had DM of which 48.7% were newly diagnosed. Having a family history of DM predicted DM with Odds Ratio (OR) of 5.36 (95% Confidence Interval, [3.67, 7.83]) followed by age ≥ 45 years (OR = 4.64, [3.18, 6.76]). Having one or more “symptoms” of DM was a significant predictor (OR 2.88, 95% CI, 2.06–4.01). Combining risk scores with symptoms predicted DM diagnosis with sensitivity of 94.7%, but specificity was low at 29.4%. In patients with known treatment outcome status, death rate was high. Conclusions: Almost a half of TB patients with DM did not know their status. A simple tool that combined risk factors with symptoms accurately predicted a subsequent diagnosis of DM. Such tools can help avoid high rates of death among TB patients suffering from DM through early detection.http://www.sciencedirect.com/science/article/pii/S2405579422000110Diabetes mellitusRisk scoringTuberculosisEarly detectionMortality |
| spellingShingle | Degu Jerene Chaltu Muleta Abdurezak Ahmed Getahun Tarekegn Tewodros Haile Ahmed Bedru Agnes Gebhard Fraser Wares High rates of undiagnosed diabetes mellitus among patients with active tuberculosis in Addis Ababa, Ethiopia Journal of Clinical Tuberculosis and Other Mycobacterial Diseases Diabetes mellitus Risk scoring Tuberculosis Early detection Mortality |
| title | High rates of undiagnosed diabetes mellitus among patients with active tuberculosis in Addis Ababa, Ethiopia |
| title_full | High rates of undiagnosed diabetes mellitus among patients with active tuberculosis in Addis Ababa, Ethiopia |
| title_fullStr | High rates of undiagnosed diabetes mellitus among patients with active tuberculosis in Addis Ababa, Ethiopia |
| title_full_unstemmed | High rates of undiagnosed diabetes mellitus among patients with active tuberculosis in Addis Ababa, Ethiopia |
| title_short | High rates of undiagnosed diabetes mellitus among patients with active tuberculosis in Addis Ababa, Ethiopia |
| title_sort | high rates of undiagnosed diabetes mellitus among patients with active tuberculosis in addis ababa ethiopia |
| topic | Diabetes mellitus Risk scoring Tuberculosis Early detection Mortality |
| url | http://www.sciencedirect.com/science/article/pii/S2405579422000110 |
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