1. Home
  2. Vol 50, No 1 (2018)
  3. Saktiawati

Influence of Diabetes Mellitus on the Development of Multi Drug Resistant-Tuberculosis in Yogyakarta

Antonia Morita Iswari Saktiawati, Yanri Wijayanti Subronto

Abstract


Background: the correlation between diabetes mellitus (DM) and Multi-Drug-Resistant Tuberculosis (MDR-TB) has never been studied among patients with tuberculosis (TB) in Indonesia, while DM has been identified to alter immune response and pharmacokinetics of TB medications that may lead to a failure of TB treatment and develop MDR-TB. Our study aimed to analyze the influence of diabetes mellitus on the development of MDR-TB. Methods: a retrospective cohort study was carried out on 356 TB patients at the Provincial Lung Clinics and Sardjito Hospital, Yogyakarta, Indonesia between 2010 and 2014. Diagnosis of MDR-TB was established based on GeneXpert or drug sensitivity testing, while DM was determined based on the criteria in the National Guidelines. Demographic, epidemiological and outcome variables were collected. Odds ratios and 95% confidence intervals (95% CI) were analyzed using simple logistic regression. Results: among 356 TB patients, 23 patients were with binomial TB-DM, while 333 patients did not suffered from DM. Patients with TB-DM presented a 6.8-fold (95% CI:2.0-23.7, p=0.003) higher risk of developing MDR-TB. Individuals with TB-DM had a 4.4-fold (95% CI:1.5-12.9, p=0.008) greater chance to have positive sputum smear by the second month of treatment indicating a delay in the resolution of the tuberculosis infection. Conclusion: there was a significant correlation between diabetes mellitus and MDR-TB development. Therefore, it is suggested that clinicians at all levels of health care service should conduct any kind of screening test for MDR-TB in such group of patients. Further prospective cohort study is needed to confirm the findings of this preliminary study.

Keywords


Diabetes mellitus; tuberculosis; risk factors; Indonesia

References


Webb EA, Hesseling AC, Schaaf HS, et al. High prevalence of mycobacterium tuberculosis infection and disease in children and adolescents with type 1 diabetes mellitus. Int J Tuberc Lung Dis. 2009;13(7):868-874.

Ottmani SE, Murray MB, Jeon CY, et al. Consultation meeting on tuberculosis and diabetes mellitus: Meeting summary and recommendations. Int J Tuberc Lung Dis. 2010;14(12):1513-1517.

Lonnroth K, Castro KG, Chakaya JM, et al. Tuberculosis control and elimination 2010-50: Cure, care, and social development. Lancet. 2010;375(9728):1814-1829.

World Health Organization. Global tuberculosis report. World Health Organization; 2016.

International Diabetes Federation. Annual report. . 2015.

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

Reviono Juliana, Indah Harsini Aphridasari, Jatu Sutanto, Yusup S. Comparison of clinical, radiological finding and culture conversion of diabetic and non diabetic multidrug resistant tuberculosis patients in dr. moewardi hospital. J Respir Indo. 2013;33(2):103.

Risky Akaputra, Erlina Burhan, Arifin Nawas. Characteristics and evaluations of illness of multidrug resistant tuberculosis with and without diabetes mellitus. J Respir Indo. 2013; 33:92-102. 2013;33:92.

Park SW, Shin JW, Kim JY, et al. The effect of diabetic control status on the clinical features of pulmonary tuberculosis. Eur J Clin Microbiol Infect

Dis. 2012;31(7):1305-1310.

Tanrikulu AC, Hosoglu S, Ozekinci T, Abakay A, Gurkan F. Risk factors for drug resistant tuberculosis in southeast turkey. Trop Doct. 2008;38(2):91-93.

Chang JT, Dou HY, Yen CL, et al. Effect of type 2 diabetes mellitus on the clinical severity and treatment outcome in patients with pulmonary tuberculosis: A potential role in the emergence of multidrug-resistance. J Formos Med Assoc. 2011;110(6):372-381.

Zhang Q, Xiao H, Sugawara I. Tuberculosis complicated by diabetes mellitus at shanghai pulmonary hospital, china. Jpn J Infect Dis. 2009;62(5):390-391.

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

Perkumpulan Endokrinologi Indonesia. Konsensus pengendalian dan pencegahan diabetes mellitus tipe 2 di indonesia. PB PERKENI, Jakarta; 2015.

World Health Organization. Treatment of tuberculosis: Guidelines– 4th ed. WHO, Geneva, Switzerland; 2010.

Nijland HM, Ruslami R, Stalenhoef JE, et al. Exposure to rifampicin is strongly reduced in patients with tuberculosis and type 2 diabetes. Clin Infect Dis. 2006;43(7):848-854.

Pasipanodya JG, Srivastava S, Gumbo T. Meta-analysis of clinical studies supports the pharmacokinetic variability hypothesis for acquired drug resistance and failure of antituberculosis therapy. Clin Infect Dis. 2012;55(2):169-177.

Pasipanodya JG, McIlleron H, Burger A, Wash PA, Smith P, Gumbo T. Serum drug concentrations predictive of pulmonary tuberculosis outcomes. J Infect Dis. 2013;208(9):1464-1473.

Gagneux S, Burgos MV, DeRiemer K, et al. Impact of bacterial genetics on the transmission of isoniazid-resistant mycobacterium tuberculosis. PLoS Pathog. 2006;2(6):e61.

Schaible UE, Kaufmann SH. Malnutrition and infection: Complex mechanisms and global impacts. PLoS Med. 2007;4(5):e115.

Guler M, Unsal E, Dursun B, Aydln O, Capan N. Factors influencing sputum smear and culture conversion time among patients with new case pulmonary tuberculosis. Int J Clin Pract. 2007;61(2):231-235.

Ponce-De-Leon A, Garcia-Garcia Md Mde L, Garcia-Sancho MC, et al. Tuberculosis and diabetes in southern mexico. Diabetes Care. 2004;27(7):1584-1590.

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

Wang JY, Lee LN, Hsueh PR. Factors changing the manifestation of pulmonary tuberculosis. Int J Tuberc Lung Dis. 2005;9(7):777-783.

Drobniewski F, Balabanova Y, Nikolayevsky V, et al. Drug-resistant tuberculosis, clinical virulence, and the dominance of the beijing strain family in russia. JAMA. 2005;293(22):2726-2731.

Farazi A, Sofian M, Zarrinfar N, Katebi F, Hoseini SD, Keshavarz R. Drug resistance pattern and associated risk factors of tuberculosis patients in the central province of iran. Caspian J Intern Med. 2013;4(4):785-789.

World Health Organization. Global tuberculosis report. 20th ed. World Health Organization; 2015.

van der Werf MJ, Langendam MW, Huitric E, Manissero D. Multidrug resistance after inappropriate tuberculosis treatment: A meta-analysis. Eur Respir J. 2012;39(6):1511-1519.

Shoelson SE, Lee J, Goldfine AB. Inflammation and insulin resistance. J Clin Invest. 2006;116(7):1793-1801.

Niazi AK, Kalra S. Diabetes and tuberculosis: A review of the role of optimal glycemic control. J Diabetes Metab Disord. 2012;11(1):28-6581-11-28.


Full Text: PDF

Refbacks

  • There are currently no refbacks.