The Effects of Diabetes Mellitus Comorbidities on the Risk of Treatment Failure in Tuberculosis Patients: A Meta-Analysis
Abstract
Background: Tuberculosis or TB is a disease caused by the Mycobacterium tuberculosis complex. There are several comorbidities that experience severity and death when infected with tuberculosis or TB, namely hypertension, diabetes mellitus, cardiovascular disease, chronic kidney disease, cerebrovascular disease, and other diseases. This study aims to estimate the magnitude of the risk of treatment failure in Tuberculosis patients with Diabetes Mellitus comorbidity, with a meta-analysis of primary studies conducted by previous authors.
Subjects and Method: This was a systematic review and meta-analysis with the following PICO, population: tuberculosis patients. Intervention: chronic comorbid diabetes mellitus. Comparison: without comorbid diabetes mellitus. Outcome: treatment failure. The articles used in this study were obtained from three databases, namely Google Scholar, PubMed, and Science Direct. Keywords to search for articles “Tuberculosis” OR “TBC” AND “Diabetes Mellitus” OR “DM” AND “Treatment failure”. The included article is a full-text English cohort study design from 2007 to 2021 and reports the adjusted odds ratio (aOR) in multivariate analysis. The selection of articles is done using PRISMA flow diagrams. Articles were analyzed using the Review Manager 5.3 application.
Results: A total of 7 cohort studies involving TB patients undergoing treatment from America, Europe, Africa and Asia were selected for systematic review and meta-analysis. The data collected showed that tuberculosis patients undergoing treatment with comorbid diabetes mellitus had a 1.57 time the risk of treatment failure compared to patients without comorbid diabetes mellitus (aOR= 1.57; 95% CI= 1.08 to 2.30; p= 0.002).
Conclusion: Comorbidity Diabetes mellitus increases the risk of experiencing treatment failure in tuberculosis patients.
Keywords: diabetes mellitus, tuberculosis, mortality.
Correspondence: Sri Iswahyuni. School of Health Sciences Mamba’ul Ulum Surakarta. Jl. Ringroad Utara, Mojosongo, Jebres, Surakarta, Central Java, Indonesia. Email: iswahyunisri@yahoo.co.id. Mobile: +62 815-6720-715.
Indonesian Journal of Medicine (2022), 07(04): 417-427
https://doi.org/10.26911/theijmed.2022.07.04.07
References
ADA (2016). Standards of medical care in diabetes2016 abridged for primary care providers. Clin Diabetes. 34(1): 321. doi: 10.2337/diaclin.34.1.3.
ADA (2018). Improving care and promoting health in populations: standards of medical care in diabetes2018. Diabetes Care. 41(1): S7–S12. doi: 10.2337/dc18S001.
AlRifai RH, Pearson F, Critchley JA, AbuRaddad LJ (2017). Association between diabetes mellitus and active Tuberkulosis: A systematic review and metaanalysis. PloS one. 12(11): e0187967. doi: 10.1371/journal.pone.0187967.
Alisjahbana B, Sahiratmadja E, Nelwan EJ, Purwa AM, Ahmad Y, Ottenhoff THM, (2007). The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin Infect Dis. 45:42835.
Aweis D, Suleiman ZAS, Mutlif AR (2010). To assess the corelation of diabetes mellitus and comorbid tuberculosis on the leucocyte and platelet counts. Arch Pharma Prac.1(1):124.
Baghaei P, Marjani M, Javanmard P, Tabarsi P, Masjedi MR (2013). Diabetes mellitus and Tuberkulosis facts and controversies. J Diabetes Metab Disord. 12 (58): 201 207. doi: 10.1186/225165811258.
Baker MA, Harries AD, Jeon CY, Hart JE, Kapur A, Lönnroth K, Ottmani SE (2011). The impact of diabetes on tuberkulosis treatment outcomes: a systematic review. BMC Med. 9:81. doi: 10.1186/17417015981.
Bertoluci M C, Cé G V, da Silva A M, Wainstein M V, Boff W, Puñales, M. (2015). Endothelial dysfunction as a predictor of cardiovascular disease in type 1 diabetes. World journal of diabetes, 6(5), 679–692. doi: 10.4239/wjd.v6.i5.679
Brostrom RJ (2010). Summary of the impact of diabetes on tuberculosis control and submission of draft standards for diabetes and tuberculosis in the USaffiliated Pacific Islands. Fifth Pacific Stop TB Meeting 47 May 2010, Nadi, Fiji Islands. [Online]. 2010. [cited 2011 March 18] Available from URL: http://www.spc.int/tb/en/publication/cat_view/69 meetings/74fifthpacificstoptbmeeting2010
CDC (2017). Estimates of diabetes and its burden in the United States. Available at https://www.cdc.gov/diabetes/pdfs/data/statistics/nationaldiabetesstatisticsreport.pdf. Accessed on 03/06 /2018
Cochrane (2014). RevMan 5.3 User Guide. Cochrane Library.
Deeks JJ, Hinggins JP, Altman DG (2021). Chapter 10: Analysing data and undertaking metaanalyses Cochrane Training. Retrieved from https://training.cochrane.org/handbook/current/chapter10
Degner NR, Wang JY, Golub JE, Karakousis PC (2018). Metformin use reverses the increased mortality associated with diabetes mellitus during Tuberkulosis treatment. Arch. Clin. Infect. Dis. 66(2): 198205. doi: 10.1093/cid/cix819.
Dooley KE, Tang T, Golub JE, Dorman SE (2009). Cronin W. Impact of diabetes mellitus on treatment outcomes of patients with active Tuberkulosis. Am J Trop Med Hyg. 80:634639.
Faurholt‐Jepsen D, Range N, PrayGod G, Jeremiah K, Faurholt‐Jepsen M, Aabye, MG, Changalucha J, et al. (2013). Diabetes is a strong predictor of mortality during Tuberkulosis treatment: a prospective cohort study among Tuberkulosis patients from M wanza,Tanzania. Trop. Med. Int. Health. 18(7). 822829. doi: 10.1111/tmi.12120.
FisherHoch SP, Whitney E, McCormick JB (2008). Type 2 diabetes and multidrug resistant tuberculosis. Scan J Infect Dis; 40(1112):88893.
Kebede W, Gudina EK, Balay G, Abebe G (2021). Diagnostic implications and inpatient mortality related to Tuberkulosis at Jimma Medical Center, southwest Ethiopia. J. Clin. Tuberc. Other Mycobact. Dis. 23. 100220. doi: 10.1016/j.jctube.2021.100220.
Magee MJ, Foote M, Maggjo DM, Howards PP, Narayan KM, Blumberg HM, Ray SM, et al. (2014). Diabetes Mellitus and Risk of AllCause Mortality among Patients with Tuberkulosis in the State of Georgia, 2009–2012 Ann Epidemiol. (24):369375. doi: 10.1016/j.annepidem.2014.01.012.
Murti B (2018). Prinsip dan Metode Riset Epidemiologi (Epidemiological Research Principles and Methods) (5th ed.). Program Studi Ilmu Kesehatan Masyarakat, Program Pascasarjana, Universitas Sebelas Maret.
Perhimpunan Dokter Paru Indonesia (2011) Tuberkulosis: pedoman diagnosis dan penatalaksanaan di Indonesia (Tuberculosis: guidelines for diagnosis and management in Indonesia). Jakarta: Indah Offset Citra Grafika. hlm.3940.
Pradipta IS, BoveneindVrubleuskaya N, Akkerman OW, Alffenaar JWC, Hak E (2019). Predictors for treatment outcomes among patients with drugsusceptible Tuberkulosis in the Netherlands: a retrospective cohort study. Clin Microbiol Infect. 25(6). 761.e1761.e7. doi: 10.1016/j.cmi.2018.10.009.
Qian X, Nguyen DT, Lyu J, Albers AE, Bi X, Graviss EA (2018). Risk factors for extrapulmonary dissemination of Tuberkulosis and associated mortality during treatment for extrapulmonary Tuberkulosis. Emerging microbes & infections. 7(1): 114. doi: 10.1038/s4142601801061.
Restrepo BI (2007). Convergence of the tuberculosis and diabetes epidemics: Renewal of old acquaintances. Clin Infect Dis; 45:4368.
Restrepo BI, FisherHoch SP, Pino PA, Salinas A, Rahbar MH, Mora F, et al (2008). Tuberculosis in poorly controlled type 2 diabetes: Altered cytokine expression in peripheral white blood cells. Clin Infect Dis.; 47:63441.
Rohman H (2018). Kasus tuberkulosis dengan riwayat diabettes mellitus di wilayah prevalensi tinggi diabettes mellitus (A case of tuberculosis with a history of diabetes mellitus in an area with a high prevalence of diabetes mellitus). Jurnal Manajemen Informasi Kesehatan Indonesia. 6(2): 149 – 156.
Tok PSK, Liew SM, Wong LP, Razali A, Loganathan T, Chinna K, Ismail N, et al. (2020). Determinants of unsuccessful treatment outcomes and mortality among Tuberkulosis patients in Malaysia: A registrybased cohort study. PloS one. 15(4), e0231986. doi: 10.1371/journal.pone.0231986.
Widiyanto A (2017). Hubungan Kepatuhan Minum Obat dengan Kesembuhan Pasien Tuberkulosis Paru BTA Positif di Puskesmas Delanggu Kabupaten Klaten (Correlation between Compliance with Taking Medication and Recovery of Positive Smear Pulmonary Tuberculosis
Patients at the Delanggu Health Center, Klaten Regency). Interest: Jurnal Ilmu Kesehatan, 6(1): 712.
Widiyanto A, Fajriah AS, Atmojo JT, Handayani RT, Kurniavie LE (2020). The effect of social media exposure on depression and anxiety disorders in facing Covid19 pandemic. European J. Mol. Clin. Med.7(2), 46354643.
Widiyanto A, Atmojo JT, Darmayanti AT (2019). Pengaruh faktor kerawanan pangan dan lingkungan terhadap stunting (Effect of food insecurity and environmental factors on stunting).J. Ilmu. Kesh, 8(1), 6166.
WHO (2017). Treatment Of Tuberkulosis Guidelines Fourth Edition. Geneva: WHO Press.
WHO (2018). Global Tuberkulosis report Geneva. World Health Organization.
WHO (2019). Global Tuberkulosis report Geneva. World Health Organization
