Presentation and Treatment Outcomes by Diabetes Status among Patients with Tuberculosis in Guam, 2015–2018 Public
O'Connor, Stephanie (Spring 2020)
Published
Abstract
Background: In areas with persistent tuberculosis (TB) incidence, increased prevalence of diabetes mellitus threatens TB elimination efforts. Previous studies have found that people with diabetes are at increased risk of developing TB, having more extensive TB disease manifestation, and suffering worse TB treatment outcomes. With a diabetes prevalence of 18.7% and TB incidence of 41.7 cases per 100,000 people, Guam’s population is among those at risk of a dual epidemic.
Objectives: First, this analysis will describe the burden and distribution of TB with concomitant diabetes in Guam. Next, it will assess the association between diabetes status and several key presentation and treatment characteristics among patients with TB. Finally, it will examine the prevalence of diabetes among foreign-born patients with TB by length of residence.
Methods: Data were collected through routine TB surveillance from 2015–2018. Patients meeting the surveillance case definition for TB who were at least 15 years of age and presented with pulmonary, drug-susceptible TB were eligible for inclusion. Diabetes was the exposure of interest, and outcome variables included positive sputum smear, pulmonary cavitation,
treatment duration, and treatment outcome. A secondary analysis including only foreign-born patients examined the odds of having diabetes based on length of residence. Multivariate logistic regression was used for both analyses.
Results: Of the 245 patients with TB eligible for inclusion, 38% had diabetes. The odds of being diabetic were 4.15 times higher among long-term immigrants compared to recent immigrants (CI 1.76–9.80). Overall, having diabetes was associated with both smear positivity and pulmonary cavitation (aOR 4.98, CI 2.63–9.44; aOR 3.61, CI 1.37–9.50). TB cases with diabetes were also more likely to have extended treatment duration and unfavorable treatment outcomes (aOR 5.69, CI 2.96–10.94; aOR 3.20, CI 1.36–7.52). The odds of death were 5.66 times higher among those with diabetes (CI 1.88–17.04).
Conclusion: There is a high burden of TB with concomitant diabetes in Guam. Diabetes was found to be associated with more severe presentation, worse treatment outcomes, and higher mortality. This analysis of Guam’s TB surveillance data suggests that diabetes is an important factor to consider in TB prevention and treatment.
Table of Contents
Table of Contents
Chapter 1 Introduction .................................................................................................................... 2
Chapter 2 Methods ........................................................................................................................... 6
Chapter 3 Results ............................................................................................................................. 9
Clinical Presentation .................................................................................................................... 9
Treatment Outcomes ................................................................................................................... 10
Length of Residence .................................................................................................................... 10
Chapter 4 Discussion ...................................................................................................................... 12
Regional Prevalence .................................................................................................................... 12
Ethnicity & Diabetes .................................................................................................................... 13
Theories on Heterogenous Diabetes Risk ................................................................................... 14
Role of Immigration .................................................................................................................... 16
Chapter 5 Limitations ..................................................................................................................... 18
Chapter 6 Implications .................................................................................................................. 20
Consequences for TB Prevention and Control Practice ............................................................. 20
Recommendations for Further Study ......................................................................................... 21
Conclusion ................................................................................................................................... 21
Chapter 7 Tables ............................................................................................................................ 23
Table 1: Demographic characteristics of patients with TB in Guam by diabetes status .......... 23
Table 2: Presentation characteristics of patients with TB in Guam by diabetes status ........... 24
Table 3: Treatment characteristics of patients with TB in Guam by diabetes status ................ 25
Table 4: Logistic regression analysis of the odds of presentation and treatment characteristics
among TB patients with concomitant diabetes compared to those with TB only ................... 26
Table 5: Length of Residence of Foreign-born Patients with TB in Guam by Diabetes Status... 27
Table 6: Logistic regression analysis of the odds of diabetes among foreign-born patients with
TB in short- and long-term residents ......................................................................................... 28
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