Diabetes and pre-diabetes among household contacts of tuberculosis patients in India: is it time to screen them all?
Diabetes and pre-diabetes among household contacts of tuberculosis patients in India: is it time to screen them all?
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DOI：
10.5588/ijtld.17.0598
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发表时间：
2018-06-01
影响因子：
4
通讯作者：
Gupta, A.
中科院分区：
文献类型：
--
作者：
Shivakumar, S. V. B. Y.;Chandrasekaran, P.;Gupta, A.
背景：糖尿病前期(Pre-DM)和糖尿病会增加患结核病(TB)的风险。对肺结核患者的接触者进行糖尿病前期筛查，并将他们与护理联系起来，可能会降低患结核病的风险，改善糖尿病的管理。目的：测量肺结核患者成年家庭接触者中糖尿病前期/糖尿病的患病率及其相关因素。方法：2014年8月至2017年5月，印度浦那和钦奈新诊断的成年肺结核患者的成年家庭接触者在登记时进行单一血样糖化血红蛋白(HbA1c)检测。DM定义为既往诊断、自我报告的DM或HbA1c>；=6.5%，DM前期定义为HbA1c在5.7%-6.4%之间。以结核菌素皮试阳性(<5 mm硬结)或Quantiferon(R)金试管试验阳性(<0.35国际单位/ml)为诊断标准。40例(%)新诊断为糖尿病，48例(75%)血糖控制不良(HbA1c和Gt；=7.0%)。68例(22%)糖尿病前期患者年龄在18-34岁之间。年龄35岁、体重指数25 kg/m(2)、慢性病和吸烟与糖尿病显著相关。结论：印度成年结核病患者中，未确诊的糖尿病、糖尿病前期和腰椎损伤的患病率较高，是结核病的高危人群。应考虑在所有成人结核病HHC中进行常规的DM筛查。
SETTING: Pre-diabetes mellitus (pre-DM) and DM increase the risk of developing tuberculosis (TB). Screening contacts of TB patients for pre-DM/DM and linking them to care may mitigate the risk of developing TB and improve DM management.OBJECTIVE: To measure the prevalence of pre-DM/DM and associated factors among the adult household contacts (HHCs) of pulmonary TB patients.METHODS: Between August 2014 and May 2017, adult HHCs of newly diagnosed adult PTB patients in Pune and Chennai, India, had single blood samples tested for glycosylated haemoglobin (HbA1c) at enrolment. DM was defined as previously diagnosed, self-reported DM or HbA1c >= 6.5%, and pre-DM as HbA1c between 5.7% and 6.4%. Latent tuberculous infection (LTBI) was defined as a positive tuberculin skin test ( >= 5 mm induration) or QuantiFERON (R) Gold In-Tube ( >0.35 international units/ml).RESULTS: Of 652 adult HHCs, 175 (27%) had pre-DM and 64 (10%) had DM. Forty (64%) HHCs were newly diagnosed with DM and 48 (75%) had poor glycaemic control (HbA1c >= 7.0%). Sixty-eight (22%) pre-DM cases were aged 18-34 years. Age >= 35 years, body mass index >= 25 kg/m(2), chronic disease and current tobacco smoking were significantly associated with DM among HHCs.CONCLUSIONS: Adult HHCs of TB patients in India have a high prevalence of undiagnosed DM, pre-DM and LTBI, putting them at high risk for developing TB. Routine DM screening should be considered among all adult HHCs of TB.