Transient Hyperglycemia in Patients With Tuberculosis in Tanzania: Implications for Diabetes Screening Algorithms
Transient Hyperglycemia in Patients With Tuberculosis in Tanzania: Implications for Diabetes Screening Algorithms
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DOI：
10.1093/infdis/jiv568
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发表时间：
2016-04-01
影响因子：
6.4
通讯作者：
Probst-Hensch, Nicole
中科院分区：
文献类型：
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作者：
Boillat-Blanco, Noemie;Ramaiya, Kaushik L.;Probst-Hensch, Nicole
背景糖尿病（DM）增加了结核病的风险，而结核病作为一种传染病，导致高血糖。我们比较了坦桑尼亚达累斯萨拉姆结核病患者和对照组的高血糖筛查策略。在2012年7月至2014年6月期间，一项病例对照研究纳入了患有结核病的成年人和性别和年龄匹配的志愿者。所有患者在入组时均接受了DM筛查检查（空腹毛细血管葡萄糖[FCG]水平、2小时CG [2-hCG]水平和糖化血红蛋白A1 c [HbA 1c]水平），并在接受结核病治疗后再次进行检查。采用logistic回归分析评估结核病及其预后与高血糖的关系，调整了性别、年龄、体重指数、人类免疫缺陷病毒感染状况和社会经济状况。结核病和新诊断的糖尿病患者不接受高血糖治疗。在登记时，结核病患者的DM患病率（n = 539; FCG水平> 7 mmol/L，4.5%的患者，2-hCG水平> 11 mmol/L，6.8%; HbA 1c水平> 6.5%，9.3%）显著高于对照组（n = 496;分别为1.2%，3.1%和2.2%）。高血糖与结核病的相关性在结核病治疗后消失（FCG水平的校正比值比[aOR]：入组时为9.6 [95%置信区间{CI}，3.7-24.7]，随访时为2.4 [95% CI，0.7 -8.7]; 2-hCG水平的aOR：6.6 [95% CI，4.0-11.1] vs 1.6 [95% CI，.8-2.9]; HbA 1c水平的aOR，4.2 [95% CI，2.9-6.0] vs 1.4 [95% CI，.9-2.0]）。根据FCG水平，高血压与肺结核治疗失败或死亡相关（aOR，3.3; 95%CI，1.2-9.3）。短暂性高血糖在结核病期间是常见的，并且DM需要在结核病治疗后确认。在结核病诊断时进行糖尿病筛查，可以发现有不良结局风险的患者。
Background. Diabetes mellitus (DM) increases tuberculosis risk while tuberculosis, as an infectious disease, leads to hyperglycemia. We compared hyperglycemia screening strategies in controls and patients with tuberculosis in Dar es Salaam, Tanzania.Methods. Consecutive adults with tuberculosis and sex- and age-matched volunteers were included in a case-control study between July 2012 and June 2014. All underwent DM screening tests (fasting capillary glucose [FCG] level, 2-hour CG [2-hCG] level, and glycated hemoglobin A1c [HbA1c] level) at enrollment, and cases were tested again after receipt of tuberculosis treatment. Association of tuberculosis and its outcome with hyperglycemia was assessed using logistic regression analysis adjusted for sex, age, body mass index, human immunodeficiency virus infection status, and socioeconomic status. Patients with tuberculosis and newly diagnosed DM were not treated for hyperglycemia.Results. At enrollment, DM prevalence was significantly higher among patients with tuberculosis (n = 539; FCG level > 7 mmol/L, 4.5% of patients, 2-hCG level > 11 mmol/L, 6.8%; and HbA1c level > 6.5%, 9.3%), compared with controls (n = 496; 1.2%, 3.1%, and 2.2%, respectively). The association between hyperglycemia and tuberculosis disappeared after tuberculosis treatment (adjusted odds ratio [aOR] for the FCG level: 9.6 [95% confidence interval {CI}, 3.7-24.7] at enrollment vs 2.4 [95% CI, .7-8.7] at follow-up; aOR for the 2-hCG level: 6.6 [95% CI, 4.0-11.1] vs 1.6 [95% CI, .8-2.9]; and aOR for the HbA1c level, 4.2 [95% CI, 2.9-6.0] vs 1.4 [95% CI, .9-2.0]). Hyperglycemia, based on the FCG level, at enrollment was associated with tuberculosis treatment failure or death (aOR, 3.3; 95% CI, 1.2-9.3).Conclusions. Transient hyperglycemia is frequent during tuberculosis, and DM needs confirmation after tuberculosis treatment. Performance of DM screening at tuberculosis diagnosis gives the opportunity to detect patients at risk of adverse outcome.