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Prevalence and Impact of Diabetes Mellitus Among Patients with Active Pulmonary Tuberculosis in South Korea

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Abstract

Objective

South Korea has an increasing prevalence of diabetes and a relatively high burden of tuberculosis. We aimed to determine the prevalence of diabetes in patients with active pulmonary tuberculosis (PTB) and examine the effect of diabetes on tuberculosis treatment outcomes.

Setting and Design

Data from patients ≥30 years diagnosed with and treated for PTB between January 2010 and December 2012 at Severance Hospital, a 2000-bed tertiary referral hospital in Seoul, South Korea, were analyzed and compared with data from a contemporaneous general population sample extracted from KNHANES V.

Results

Diabetes prevalence was 24.2% (252/1044) among patients with PTB and 11.6% (1700/14,655) among controls. Diabetes [odds ratios (OR) 2.56, 95% confidence interval (CI) 1.56–4.21, P < 0.001], male sex (OR 1.93, 95% CI 1.08–3.44, P = 0.027), and cavitary disease (OR 2.08, 95% CI 1.29–3.35, P = 0.003) were significant risk factors for 2-month culture positivity. Diabetes was the only factor associated with unsuccessful treatment outcomes (OR 1.67, 95% CI 1.03–2.70, P = 0.039).

Conclusion

The prevalence of diabetes was markedly higher in patients with PTB than in a sample of the general South Korean population. Diabetes may delay sputum conversion and adversely affect treatment outcomes; detection and management of diabetes in patients with PTB is crucial.

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References

  1. World Health Organisation (2015) Global tuberculosis report 2015. World Health Organization, Geneva

    Google Scholar 

  2. Kim DJ (2011) The epidemiology of diabetes in Korea. Diabetes Metab J 35(4):303–308

    Article  PubMed  PubMed Central  Google Scholar 

  3. Baker MA, Harries AD, Jeon CY et al (2011) The impact of diabetes on tuberculosis treatment outcomes: a systematic review. BMC Med 9:81

    Article  PubMed  PubMed Central  Google Scholar 

  4. Jeon CY, Murray MB (2008) Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med 5(7):1091–1101

    Article  Google Scholar 

  5. Dooley KE, Chaisson RE (2009) Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis 9(12):737–746

    Article  PubMed  PubMed Central  Google Scholar 

  6. American Diabetes Association (2012) Diagnosis and classification of diabetes mellitus. Diabetes Care 35 Suppl 1:S64–S71

    Article  Google Scholar 

  7. Blumberg HM, Burman WJ, Chaisson RE et al (2003) American thoracic society/centers for disease control and prevention/infectious diseases society of America: treatment of tuberculosis. Am J Respir Crit Care Med 167(4):603–662

    Article  PubMed  Google Scholar 

  8. Jo KW, Yoo JW, Hong Y et al (2014) Risk factors for 1-year relapse of pulmonary tuberculosis treated with a 6-month daily regimen. Respir Med 108(4):654–659

    Article  PubMed  Google Scholar 

  9. Alisjahbana B, van Crevel R, Sahiratmadja E et al (2006) Diabetes mellitus is strongly associated with tuberculosis in Indonesia. Int J Tuberc Lung Dis 10(6):696–700

    CAS  PubMed  Google Scholar 

  10. Sulaiman SA, Khan AH, Muttalif AR et al (2013) Impact of diabetes mellitus on treatment outcomes of tuberculosis patients in tertiary care setup. Am J Med Sci 345(4):321–325

    Article  PubMed  Google Scholar 

  11. Kornfeld H, West K, Kane K et al (2016) High prevalence and heterogeneity of diabetes in patients with TB in South India: a report from the effects of diabetes on tuberculosis severity (E.S) Study. Chest 149(6):1501–1508

    Article  PubMed  Google Scholar 

  12. Kim SJ, Hong YP, Lew WJ et al (1995) Incidence of pulmonary tuberculosis among diabetics. Tuber Lung Dis 76(6):529–533

    Article  CAS  PubMed  Google Scholar 

  13. Bloomgarden ZT (2003) Inflammation and insulin resistance. Diabetes Care 26(5):1619–1623

    Article  CAS  PubMed  Google Scholar 

  14. Chang FY, Shaio MF (1995) Decreased cell-mediated immunity in patients with non-insulin-dependent diabetes mellitus. Diabetes Res Clin Pract 28(2):137–146

    Article  CAS  PubMed  Google Scholar 

  15. Moutschen MP, Scheen AJ, Lefebvre PJ (1992) Impaired immune responses in diabetes mellitus: Analysis of the factors and mechanisms involved. Relevance to the increased susceptibility of diabetic patients to specific infections. Diabete Metab 18(3):187–201

    CAS  PubMed  Google Scholar 

  16. Wang CH, Yu CT, Lin HC et al (1999) Hypodense alveolar macrophages in patients with diabetes mellitus and active pulmonary tuberculosis. Tuber Lung Dis 79(4):235–242

    Article  PubMed  Google Scholar 

  17. Alisjahbana B, Sahiratmadja E, Nelwan EJ et al (2007) The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin Infect Dis 45(4):428–435

    Article  PubMed  Google Scholar 

  18. Rekha VVB, Balasubramanian R, Swaminathan S et al (2007) Sputum conversion at the end of intensive phase of category-1 regimen in the treatment of pulmonary tuberculosis patients with diabetes mellitus or HIV infection: an analysis of risk factors. Indian J Med Res 126(5):452–458

    CAS  Google Scholar 

  19. Singla R, Khan N, Al-Sharif N et al (2006) Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients. Int J Tuberc Lung Dis 10(1):74–79

    CAS  PubMed  Google Scholar 

  20. Jimenez-Corona ME, Cruz-Hervert LP, Garcia-Garcia L et al (2013) Association of diabetes and tuberculosis: impact on treatment and post-treatment outcomes. Thorax 68(3):214–220

    Article  PubMed  Google Scholar 

  21. Shariff NM, Safian N (2015) Diabetes mellitus and its influence on sputum smear positivity at the 2nd month of treatment among pulmonary tuberculosis patients in Kuala Lumpur, Malaysia: a case control study. Int J Mycobacteriol 4(4):323–329

    Article  PubMed  Google Scholar 

  22. Viswanathan V, Vigneswari A, Selvan K et al (2014) Effect of diabetes on treatment outcome of smear-positive pulmonary tuberculosis—a report from South India. J Diabetes Complicat 28(2):162–165

    Article  PubMed  Google Scholar 

  23. Jiménez-Corona ME, Cruz-Hervert LP, García-García L et al (2013) Association of diabetes and tuberculosis: impact on treatment and post-treatment outcomes. Thorax 68(3):214–220

    Article  PubMed  Google Scholar 

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

    PubMed  PubMed Central  Google Scholar 

  25. Güler M, Ünsal E, Dursun B et al (2007) Factors influencing sputum smear and culture conversion time among patients with new case pulmonary tuberculosis. Int J Clin Pract 61(2):231–235

    Article  PubMed  Google Scholar 

  26. Restrepo BI, Fisher-Hoch SP, Smith B et al (2008) Short report: Mycobacterial clearance from sputum is delayed during the first phase of treatment in patients with diabetes. Am J Trop Med Hyg 79(4):541–544

    PubMed  PubMed Central  Google Scholar 

  27. Leung CC, Lam TH, Chan WM et al (2008) Diabetic control and risk of tuberculosis: a cohort study. Am J Epidemiol 167(12):1486–1494

    Article  PubMed  Google Scholar 

  28. Restrepo BI, Fisher-Hoch SP, Pino PA et al (2008) Tuberculosis in poorly controlled type 2 diabetes: Altered cytokine expression in peripheral white blood cells. Clin Infect Dis 47(5):634–641

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Yamashiro S, Kawakami K, Uezu K et al (2005) Lower expression of Th1-related cytokines and inducible nitric oxide synthase in mice with streptozotocin-induced diabetes mellitus infected with Mycobacterium tuberculosis. Clin Exp Immunol 139(1):57–64

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This study was supported by a faculty research grant of Yonsei University College of Medicine for 2013 (6-2013-0056).

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Authors and Affiliations

  1. Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Institute of Chest Diseases, Yonsei University College of Medicine, 50−1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea

    Eun Hye Lee, Jung Mo Lee, Young Ae Kang, Ah Young Leem, Eun Young Kim, Ji Ye Jung, Moo Suk Park, Young Sam Kim, Se Kyu Kim, Joon Chang & Song Yee Kim

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  1. Eun Hye Lee
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  2. Jung Mo Lee
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  3. Young Ae Kang
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  4. Ah Young Leem
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  5. Eun Young Kim
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  6. Ji Ye Jung
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  7. Moo Suk Park
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  8. Young Sam Kim
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  9. Se Kyu Kim
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  10. Joon Chang
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  11. Song Yee Kim
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Corresponding author

Correspondence to Song Yee Kim.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

The research protocol was approved by the Institutional Review Board (IRB) of Severance Hospital (IRB No. 4-2012-0840).

Informed Consent

Informed consent was waived due to the retrospective nature of the study.

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Lee, E.H., Lee, J.M., Kang, Y.A. et al. Prevalence and Impact of Diabetes Mellitus Among Patients with Active Pulmonary Tuberculosis in South Korea. Lung 195, 209–215 (2017). https://doi.org/10.1007/s00408-017-9978-4

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  • DOI: https://doi.org/10.1007/s00408-017-9978-4

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