Diabetes Mellitus Among Pulmonary Tuberculosis Patients From 4 Tuberculosis-endemic Countries: The TANDEM Study

Background Diabetes mellitus (DM) increases active tuberculosis (TB) risk and worsens TB outcomes, jeopardizing TB control especially in TB-endemic countries with rising DM prevalence rates. We assessed DM status and clinical correlates in TB patients across settings in Indonesia, Peru, Romania, and South Africa. Methods Age-adjusted DM prevalence was estimated using laboratory glycated hemoglobin (HbA1c) or fasting plasma glucose in TB patients. Detailed and standardized sociodemographic, anthropometric, and clinical measurements were made. Characteristics of TB patients with or without DM were compared using multilevel mixed-effect regression models with robust standard errors. Results Of 2185 TB patients (median age 36.6 years, 61.2% male, 3.8% human immunodeficiency virus–infected), 12.5% (267/2128) had DM, one third of whom were newly diagnosed. Age-standardized DM prevalence ranged from 10.9% (South Africa) to 19.7% (Indonesia). Median HbA1c in TB–DM patients ranged from 7.4% (Romania) to 11.3% (Indonesia). Compared to those without DM, TB–DM patients were older and had a higher body mass index (BMI) (P value < .05). Compared to those with newly diagnosed DM, TB patients with diagnosed DM had higher BMI and HbA1c, less severe TB, and more frequent comorbidities, DM complications, and hypertension (P value < .05). Conclusions We show that DM prevalence and clinical characteristics of TB–DM vary across settings. Diabetes is primarily known but untreated, hyperglycemia is often severe, and many patients with TB–DM have significant cardiovascular disease risk and severe TB. This underlines the need to improve strategies for better clinical management of combined TB and DM

Skewed distributions - new outcome measures

The traditional measure of caries, the DMF index, either as prevalence or incidence of disease, has become highly positively skewed among children and young adults. Most discussion of skewed distributions has focused on the properties of statistical analyses using such data or the implications for sample sizes and subject selection in clinical trials. This paper examines the full range of epidemiologic studies, their aims and constitutive interest in order to identify the measurement problems associated with skewed DMF index data. Constitutive interests include: description; documentation; explanation and prediction; evaluation; advocacy; and, experimentation. 'New' outcome measures that would assist in reaching the aims and constitutive interests of the epidemiology of caries include caries severity grading, variants of prevalence, extent and severity and their combination into case definitions, and weighting of the components of the DMF index. Research questions for each area of 'new' outcome measures are identified as steps in the codifying of their use in the epidemiology of caries