Objective
Tuberculosis is one of the most prevalent diseases worldwide, and is the most frequent infectious cause of death. Diabetes is also one of the most common non-communicable diseases worldwide, with substantial increases in low-and-middle income countries in recent years. Due to the synergy between these two diseases, low-and-middle income countries are facing difficulties to control both diseases, largely because there is no adequate information on tuberculosis-diabetes comorbidity. This study sought to improve the understanding of the co-occurrence of tuberculosis and diabetes in Peru, with the overarching aim to provide critical evidence to inform Peruvian disease control and health prevention programs.
Methods
First, we conducted a systematic review and meta-analysis in double high burden tuberculosis and diabetes countries was done to evaluate the role of Diabetes on Tuberculosis treatment outcomes. Second, to evaluate the epidemiology of diabetes in Peruvian tuberculosis patients, we conducted a cross-sectional study of 484 tuberculosis patients in Lima, evaluating diabetes prevalence and risk factors for the co-occurrence of tuberculosis and diabetes. Finally, mortality and factors associated with diabetes among tuberculosis multi-drug resistant (MDR-TB) patients in Lima was done using the information on the 1999 MDR-TB patients at the National Tuberculosis Program in Peru.
Results
In the systematic review, diabetes was associated with an increased risk for poor treatment outcomes among tuberculosis patients. Among Peruvian tuberculosis patients, diabetes was associated with older age and higher body mass index (BMI). In the cohort study among MDR-TB patients enrolled in Lima between 2010 and 2013, higher mortality was found among patients with diabetes, and MDR-TB patients with diabetes were associated with older age and higher BMI.
Conclusions
Tuberculosis-Diabetes comorbidity is more common in low-and-middle income countries like Peru than HIV. The presence of diabetes is associated with poor tuberculosis treatment outcomes and may put in jeopardy the advances in tuberculosis control in high burden countries. Considering the increasing incidence of diabetes in low-and-middle income countries, an adequate programmatic management involving both health programs (tuberculosis and diabetes) is required to reduce the burden of this comorbidity. Challenges at the health system level involving an adequate screening, including glucose test at Tuberculosis diagnosis and during the treatment may also be needed
