Diabetes mellitus and treatment outcomes of pulmonary tuberculosis: a cohort study



This study aimed to investigate the impact of diabetes on the treatment outcomes among pulmonary TB patients in Yerevan, Armenia.


We utilized a cohort study design that included TB patients with diabetes and TB patients without diabetes. The data collection was conducted in the National Tuberculosis Control Center, eight tuberculosis outpatient centers and the ‘Prisoners’ Hospital’ in Yerevan, Armenia. Data were collected from an existing national TB database and patients medical records. Multivariable logistic regressions were conducted to construct the final model and test the associations.


The final sample included 621 patients 5.8% of whom had diabetes. The odds of having treatment failure was 8.99 times higher among TB patients with diabetes (95% confidence interval 2.51–32.23) compared to TB patients without diabetes after adjusting for weight and sputum smear status.


Diabetes comorbidity had a negative effect on TB treatment outcomes. Countries with a high burden of both TB and diabetes need to develop mechanisms for active screening for diabetes among patients with TB and address their treatment needs carefully.

This is a preview of subscription content, log in to check access.


  1. Alisjahbana B, van Crevel R, Sahiratmadja E, den Heijer M, Maya A, Istriana E, van der Meer JW (2006) Diabetes mellitus is strongly associated with tuberculosis in Indonesia. Int J Tuberc Lung Dis Off J Int Union Against Tuberc Lung Dis 10(6):696–700

    CAS  Google Scholar 

  2. Alisjahbana B, Sahiratmadja E, Nelwan EJ, Purwa AM, Ahmad Y, Ottenhoff THM, van Crevel R (2007) The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin Infect Dis Off Publ Infect Dis Soc Am 45(4):428–435. https://doi.org/10.1086/519841

    Article  Google Scholar 

  3. Andreasyan D, Bazarchyan Al, Manukyan S, Muradyan G, Torosyan A, Chamanyan A, Bidzyan L, Zelveyan P (2016) Health System Performance Assessment, Armenia. National Institute of Health named after academician S. Abdalbekyan, MoH, RA

  4. Baker MA, Harries AD, Jeon CY, Hart JE, Kapur A, Lönnroth K, Murray MB (2011) The impact of diabetes on tuberculosis treatment outcomes: a systematic review. BMC Med 9(1):81. https://doi.org/10.1186/1741-7015-9-81

    Article  PubMed  PubMed Central  Google Scholar 

  5. Baldé NM, Camara A, Camara LM, Diallo MM, Kaké A, Bah-Sow OY (2006) Associated tuberculosis and diabetes in Conakry, Guinea: prevalence and clinical characteristics. Int J Tuberc Lung Dis Off J Int Union Against Tuberc Lung Dis 10(9):1036–1040

    Google Scholar 

  6. Curbing Diabetes Vital to Controlling TB (2015) Retrieved 20 April 2015 from http://www.globalhealthnow.org/news/curbing-diabetes-vital-to-controlling-tb

  7. Dooley KE, Tang T, Golub JE, Dorman SE, Cronin W (2009) Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. Am J Trop Med Hyg 80(4):634–639

    Article  Google Scholar 

  8. European Centre for Disease Prevention and Control/WHO Regional Office for Europe (2013) Tuberculosis surveillance and monitoring in Europe 2013. European Centre for Disease Prevention and Control, Stockholm

  9. European Centre for Disease Prevention and Control/WHO Regional Office for Europe (2016) Tuberculosis surveillance and monitoring in Europe 2016. European Centre for Disease Prevention and Control, Stockholm

  10. Gler MT, Guilatco R, Caoili JC, Ershova J, Cegielski P, Johnson JL (2013) Weight gain and response to treatment for multidrug-resistant tuberculosis. Am J Trop Med Hyg 89(5):943–949. https://doi.org/10.4269/ajtmh.13-0011

    Article  PubMed  PubMed Central  Google Scholar 

  11. Grigoryan R, Truzyan N, Martirosyan H, Crape B, Petrosyan V, Antonyan M (2008) Analysis of the TB Control System in Armenia in Both the Civilian and Penitentiary Sectors and Recommendations for Improvement: consultancy on reviewing the health system strengthening component of the TB Control in Prisons program in Armenia as part of the Hand-over Take-over Process review. American University of Armenia, Center for Health Services Research and Development, Yerevan, Armenia

  12. Han X, Wang Q, Wang Y, Cai J, Ma Y, Zhou X, Dou X (2016) The impact of diabetes on tuberculosis treatment outcomes: evidence based on a cumulative meta-analysis. Int J Diabetes Dev Ctries 36(4):490–507. https://doi.org/10.1007/s13410-016-0514-5

    CAS  Article  Google Scholar 

  13. Harries AD, Billo N, Kapur A (2009) Links between diabetes mellitus and tuberculosis: should we integrate screening and care? Trans R Soc Trop Med Hyg 103(1):1–2. https://doi.org/10.1016/j.trstmh.2008.08.008

    Article  PubMed  Google Scholar 

  14. International Diabetes Federation (2015) Diabetes: facts and figures. Retrieved 18 Nov 2016 from http://www.idf.org/about-diabetes/facts-figures

  15. Jeon CY, Murray MB (2008) Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med 5(7):e152. https://doi.org/10.1371/journal.pmed.0050152

    Article  PubMed Central  Google Scholar 

  16. Jiménez-Corona ME, Cruz-Hervert LP, García-García L, Ferreyra-Reyes L, Delgado-Sánchez G, Bobadilla-Del-Valle M, Ponce-de-León A (2013) Association of diabetes and tuberculosis: impact on treatment and post-treatment outcomes. Thorax 68(3):214–220. https://doi.org/10.1136/thoraxjnl-2012-201756

    Article  PubMed  Google Scholar 

  17. Kornum JB, Thomsen RW, Riis A, Lervang HH, Schønheyder HC, Sørensen HT (2007) Type 2 diabetes and pneumonia outcomes: a population-based cohort study. Diabetes Care 30(9):2251–2257. https://doi.org/10.2337/dc06-2417

    Article  PubMed  Google Scholar 

  18. Kühlbrandt C, Balabanova D, Chikovani I, Petrosyan V, Kizilova K, Ivaniuto O, McKee M (2014) In search of patient-centred care in middle income countries: the experience of diabetes care in the former Soviet Union (Amsterdam, Netherlands). Health Policy 118:193–200. https://doi.org/10.1016/j.healthpol.2014.08.009

    Article  PubMed  Google Scholar 

  19. Lau D, Eurich DT, Majumdar SR, Katz A, Johnson JA (2014) Working-age adults with diabetes experience greater susceptibility to seasonal influenza: a population-based cohort study. Diabetologia 57(4):690–698. https://doi.org/10.1007/s00125-013-3158-8

    Article  PubMed  Google Scholar 

  20. Martins M, Boavida JM, Raposo JF, Froes F, Nunes B, Ribeiro RT, Penha-Gonçalves C (2016) Diabetes hinders community-acquired pneumonia outcomes in hospitalized patients. BMJ Open Diabetes Res Care 4(1):e000181. https://doi.org/10.1136/bmjdrc-2015-000181

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  21. Mboussa J, Monabeka H, Kombo M, Yokolo D, Yoka-Mbio A, Yala F (2003) Course of pulmonary tuberculosis in diabetics. Rev Pneumol Clin 59(1):39–44

    CAS  PubMed  Google Scholar 

  22. Muñoz-Quiles C, López-Lacort M, Ampudia-Blasco FJ, Díez-Domingo J (2017) Risk and impact of herpes zoster on patients with diabetes: a population-based study, 2009–2014. Hum Vaccines Immunother 13(11):2606–2611. https://doi.org/10.1080/21645515.2017.1368600

    Article  Google Scholar 

  23. National Statistical Serivce of the Republic of Armenia. Demographic Database (n.d.) Retrieved 20 Nov 2016 from http://www.armstat.am/en/?nid=420

  24. NCD Alliance (n.d.) Diabetes. The Burden. Retrieved 18 Nov 2016 from https://ncdalliance.org/diabetes

  25. Niazi AK, Kalra S (2012) Diabetes and tuberculosis: a review of the role of optimal glycemic control. J Diabetes Metab Disord 11(1):28. https://doi.org/10.1186/2251-6581-11-28

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. Nijland HMJ, Ruslami R, Stalenhoef JE, Nelwan EJ, Alisjahbana B, Nelwan RHH, van Crevel R (2006) Exposure to rifampicin is strongly reduced in patients with tuberculosis and type 2 diabetes. Clin Infect Dis Off Publ Infect Dis Soc Am 43(7):848–854. https://doi.org/10.1086/507543

    CAS  Article  Google Scholar 

  27. Quy HT, Cobelens FG, Lan NT, Buu TN, Lambregts CS, Borgdorff MW (2006) Treatment outcomes by drug resistance and HIV status among tuberculosis patients in Ho Chi Minh City, Vietnam. Int J Tuberc Lung Dis Off J Int Union Against Tuberc Lung Dis 10(1):45–51

    CAS  Google Scholar 

  28. RA Government Decree N 21 (2008) Retrieved 2 March 2019 from https://www.arlis.am/documentview.aspx?docid=112873

  29. Restrepo BI, Fisher-Hoch SP, Crespo JG, Whitney E, Perez A, Smith B, McCormick JB (2007) Type 2 diabetes and tuberculosis in a dynamic bi-national border population. Epidemiol Infect 135(3):483–491. https://doi.org/10.1017/S0950268806006935

    CAS  Article  PubMed  Google Scholar 

  30. Santha T, Garg R, Frieden TR, Chandrasekaran V, Subramani R, Gopi PG, Narayanan PR (2002) Risk factors associated with default, failure and death among tuberculosis patients treated in a DOTS programme in Tiruvallur District, South India, 2000. Int J Tuberc Lung Dis (IJTLD) 6(May):780–788

    CAS  Google Scholar 

  31. Sterling TR, Zhao Z, Khan A, Chaisson RE, Schluger N, Mangura B, Vernon A (2006) Mortality in a large tuberculosis treatment trial: modifiable and non-modifiable risk factors. Int J Tuberc Lung Dis Off J Int Union Against Tuberc Lung Dis 10(5):542–549

    CAS  Google Scholar 

  32. Stevenson CR, Critchley JA, Forouhi NG, Roglic G, Williams BG, Dye C, Unwin NC (2007a) Diabetes and the risk of tuberculosis: a neglected threat to public health? Chronic Illn 3(3):228–245. https://doi.org/10.1177/1742395307081502

    Article  PubMed  Google Scholar 

  33. Stevenson CR, Forouhi NG, Roglic G, Williams BG, Lauer JA, Dye C, Unwin N (2007b) Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence. BMC Public Health 7:234. https://doi.org/10.1186/1471-2458-7-234

    Article  PubMed  PubMed Central  Google Scholar 

  34. Vorburger M (n.d.) Simple power calculations: how do we know we are doing them the right way. In: ASA Section on Survey Research Methods (Third)

  35. World Health Organization (2012) Tuberculosis profile, Armenia. Retrieved 7 Feb 2018 from https://extranet.who.int/sree/Reports?op=Replet&name=/WHO_HQ_Reports/G2/PROD/EXT/TBCountryProfile&ISO2=AM&LAN=EN&outtype=html

  36. World Health Organization (2013) Definitions and reporting framework for tuberculosis – 2013 revision, 2013 revision. World Health Organization. https://apps.who.int/iris/handle/10665/79199

  37. World Health Organization (2016) Tuberculosis. Fact Sheet. Retrieved 20 Nov 2016 from http://www.who.int/mediacentre/factsheets/fs104/en/

Download references


This project could not have been accomplished without the support of the National TB Control Center of Armenia. We would like to thank specially NTCC director Dr. Armen Hayrapetyan, Drs. Karapet Davtyan and Hayk Davtyan as well as all TB health care providers for their cooperation during the data collection period.

Author information




SS, VP and LA designed the study; SS collected and analyzed the data and drafted the manuscript; VP and LA contributed to the development of the manuscript. All authors contributed toward finalizing the manuscript and approved the final version for submission.

Corresponding author

Correspondence to Serine Sahakyan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Considering the nature of the study (secondary data analysis), the requirement of the informed consent was waived.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Minor Revision: 15 February 2019.

Major Revision: 05 June 2019.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Sahakyan, S., Petrosyan, V. & Abrahamyan, L. Diabetes mellitus and treatment outcomes of pulmonary tuberculosis: a cohort study. Int J Public Health 65, 37–43 (2020). https://doi.org/10.1007/s00038-019-01277-2

Download citation


  • Treatment failure
  • Cohort study
  • Tuberculosis
  • Diabetes