TABLE 6.
The impact of DM on treatment outcomes in TB patients.
| Ref. Country, year | Research design |
Sample size (n) |
Treatment regimen | Treatment outcomes n (%) | Results | Conclusion |
|---|---|---|---|---|---|---|
| [197] China, 2017 | Prospective study |
TB: 21,414 DM‐TB: 3331 |
WHO recommended HRZ‐containing standard regimens |
(1) Treatment success: NDM‐TB, n = 13,726 (78.5%) DM‐TB, n = 2368 (73.9%) (2) Still on treatment: NDM‐TB, n = 1340 (7.7%) DM‐TB, n = 368 (11.5%) (3) Death: NDM‐TB, n = 1152 (6.6%) DM‐TB, n = 316 (9.9%) |
Patients with DM‐TB complications have a lower success rate than patients with TB (adjusted OR = 0.83, 95% CI: 0.75–0.93, p = 0.001). | DM adversely affected the clinical presentation and treatment response of TB, but there was no difference in the drug resistance and relapse rates. |
| [198] Pakistan, 2016 | Prospective cohort study |
TB: 614 DM‐TB: 113 |
NTP, WHO |
(1) Treatment success, n = 434 (86%) (2) Treatment failed, n = 69 (14%) |
Patients with DM‐TB were more likely to have adverse outcomes than NDM‐TB (OR = 2.6, 95% CI: 1.48–4.56, p = 0.001). | Patients with DM‐TB were more likely to have adverse outcomes. |
| [199] South Korea, 2017 | Retrospective |
TB: 1044 DM‐TB: 253 |
WHO guidelines |
(1) Treatment success: NDM‐TB, n = 649 (84.9%) DM‐TB, n = 177 (74.4%) (2) Unsuccessfully treated: NDM‐TB, n = 115 (15.1%) DM‐TB, n = 61 (25.6%) (3) Died: NDM‐TB, n = 28 (3.7%) DM‐TB, n = 7 (2.9%) |
Diabetes was a risk factor for unsuccessful treatment outcomes OR = 1.67, 95% CI (1.03–2.70), p = 0.039. | Diabetes may delay sputum conversion and adversely affect treatment outcomes. |
| [200] China, 2015 | Retrospective |
TB: 1473 DM‐TB: 705 |
WHO guidelines |
(1) Treatment success: DM‐TB, n = 590 (83.7%) NDM‐TB, n = 687 (89.5%) (2) Treatment failed: DM‐TB, n = 22 (3.1%) NDM‐TB, n = 17 (2.2%) (3) Died: DM‐TB, n = 79 (11.2%) NDM‐TB, n = 61 (7.9%) |
DM‐TB patients were significantly less likely to have treatment success (OR = 0.61, 95% CI: 0.45–0.82). DM‐TB patients were significantly increased risk of death (OR = 1.46, 95% CI: 1.03–2.08). |
Poor glycemic control is associated with poor TB treatment outcome, and improved glycemic control may reduce the influence of diabetes on TB. |
| [201] Maryland, 2009 | Retrospective cohort study |
TB: 297 DM‐TB: 42 |
DOTS |
Died: DM‐TB, n = 6 (14.3%) NDM‐TB, n = 20 (7.8%) |
Mortality of tuberculosis patients affected by diabetes (adjusted OR = 6.5, 95% CI: 1.1–38.0, p = 0.039). | DM was a risk factor for death in Maryland TB patients. |
| [202] Armenia, 2020 | Retrospective cohort |
TB: 621 DM‐TB: 36 |
WHO guidelines |
(1) Treatment success: DM‐TB, n = 26 (72.22%) NDM‐TB, n = 484 (82.74%) (2) Treatment failed: DM‐TB, n = 4 (11.11%) NDM‐TB, n = 34 (5.81%) (3) Died: DM‐TB, n = 3 (8.33%) NDM‐TB, n = 34 (5.81%) |
The odds ratio for treatment failure among DM‐TB patients was 8.99 (95% CI: 2.591–32.23), p < 0.001. | Diabetes comorbidity had a negative effect on TB treatment outcomes. |
| [203] Japan, 2014 | Retrospective |
TB: 260 DM‐TB: 69 |
Japanese guidelines: DOTS |
Cavity: DM‐TB, n = 49 (71%) NDM‐TB, n = 87 (45.6%) |
DM is the major determinant for delayed sputum culture conversion at 2 months after treatment, with OR = 3.108 (95% CI: 1.698–5.708), p = 0.0003. | Compared with non‐DM patients, patients with DM had an increase in pulmonary cavities and a significantly longer transformation time of sputum culture. |
| [204] Mexico, 2012 | Prospective |
TB: 1262 DM‐TB: 374 |
Mexico's National TB Control Program guidelines; WHO; DOTS. |
(1) Treatment success: DM‐TB, n = 259 (71.35%) NDM‐TB, n = 605 (71.43%) (2) Treatment failed: DM‐TB, n = 17 (4.68%) NDM‐TB, n = 19 (2.24%) (3) Died: DM‐TB, n = 11 (3.03%) NDM‐TB, n = 36 (4.25%) |
Patients with DM‐TB had a higher probability of treatment failure (adjusted OR = 2.93, 95% CI: 1.18–7.23), recurrence (adjusted HR = 1.76, 95% CI 1.11–2.79), and relapse (adjusted HR = 1.83, 95% CI: 1.04–3.23). | DM‐TB patients exhibit severe clinical manifestations, delayed sputum conversion, and a higher likelihood of treatment failure, recurrence, and relapse. |
| [205] India, 2016 | Prospective |
TB: 316 DM‐TB: 50 |
RNTCP |
(1) Treatment success: DM‐TB, n = 26 (72.2%) NDM‐TB, n = 93 (62%) (2) Treatment failed: DM‐TB, n = 2 (5.6%) NDM‐TB, n = 3 (2.0%) (3) Died: DM‐TB, n = 1 (2.8%) NDM‐TB, n = 9 (6.0%) |
The risk of unsuccessful treatment outcomes in DM‐TB patients was OR = 1.176, 95% CI (0.310–4.457). | DM affects treatment outcomes for TB patients. |
| [206] Ethiopia, 2016 | Prospective cohort study |
TB: 1314 DM‐TB: 109 |
WHO guidelines, DOTS |
(1) Treatment success: DM‐TB, n = 26 (23.9%) NDM‐TB, n = 291 (24.1%) (2) Treatment failed: DM‐TB, n = 1 (0.9%) NDM‐TB, n = 14 (1.2%) (3) Died: DM‐TB, n = 15 (13.8%) NDM‐TB, n = 42 (3.5%) |
DM‐TB is associated with increased mortality adjusted HR = 3.96, 95% CI (1.76–8.89), p < 0.001. | DM is associated with increased death during TB treatment. |
| [207] Mexico, 2015 | Retrospective |
TB: 181,378 DM‐TB: 34,988 |
WHO, DOTS |
(1) Treatment success: DM‐TB, n = 25,623 (86.76%) NDM‐TB, n = 84.302 (80.54%) (2) Treatment failed: DM‐TB, n = 621 (2.1%) NDM‐TB, n = 1666 (1.59%) (3) Died: DM‐TB, n = 1973 (6.68%) NDM‐TB, n = 10,465 (9.16%) |
Treatment failure in patients with DM‐TB comorbidity adjusted OR = 1.34, 95% CI (1.11–1.61), p = 0.002. | Patients with DM‐TB are more likely to fail treatment. |
| [208] China, 2015 | Prospective |
TB: 1126 DM‐TB: 182 |
Chinese guidelines |
(1) Treatment success: DM‐TB, n = 162 (89.0%) NDM‐TB, n = 904 (95.8%) (2) Treatment failed: DM‐TB, n = 6 (3.3%) NDM‐TB, n = 5 (0.5%) |
Treatment failure in patients with DM‐TB comorbidity OR = 6.696, 95% CI (2.019–22.200), p = 0.002. | DM is associated with TB treatment failure. |
| [209] South Korea, 2017 | Prospective |
TB:661 DM‐TB: 157 (Uncontrolled‐DM: 108, Controlled‐DM: 49) |
WHO guidelines |
(1) Treatment success: Uncontrolled‐DM, n = 45 (48.4%) Controlled‐DM, n = 25 (62.5%) NDM‐TB, n = 241 (53.3%) (2) Treatment failed: Uncontrolled‐DM, n = 5 (5.4%) Controlled‐DM, n = 1 (2.5%) NDM‐TB, n = 3 (0.7%) (3) Died: Uncontrolled‐DM, n = 4 (4.3%) Controlled‐DM: NDM‐TB, n = 2 (0.4%) |
Uncontrolled DM is an independent risk factor for unsuccessful treatment outcomes in PTB. OR = 9.80, 95% CI (0.32–30.07), p < 0.001. | Uncontrolled diabetes is an independent risk factor for poor treatment response in PTB. |
| [210] China, 2013 | Retrospective cohort |
TB: 1589 DM‐TB: 189 |
WHO guidelines |
(1) Treatment success: DM‐TB, n = 77 (79.4%) NDM‐TB, n = 416 (86.1%) (2) Treatment failed: DM‐TB, n = 10 (10.3%) NDM‐TB, n = 11 (2.3%) (3) Died: DM‐TB, n = 2 (2.1%) NDM‐TB, n = 2 (0.4%) |
Treatment failure in patients with DM‐TB comorbidity OR = 4.46, 95% CI (1.96–10.18), p < 0.001. | DM is associated with TB treatment failure. |
Abbreviations: DM, diabetes mellitus; DOTS, Directly Observed Treatment Short course; H, isoniazid; Z, pyrazinamide; NDM, non‐diabetes mellitus; NTP, National Tuberculosis Control Program; PTB, pulmonary tuberculosis; R, rifampicin; RNTCP, Revised National TB Control Program; TB, Tuberculosis; WHO, The World Health Organization.