Transient Impact of Dysglycemia on Sputum Conversion Clinical Medicine Insights: Circulatory,Respiratory and Pulmonary Medicine
among Smear-Positive Tuberculosis Patients in a Tertiary Volume 15: 1–8© The Author(s) 2021
Care Facility in Ghana Article reuse guidelines:sagepub.com/journals-permissions
DOI: 10.1177/11795484211039830
Ernest Yorke1 , Vincent Boima1, Ida Dzifa Dey1, Maame-
Boatemaa Amissah-Arthur1, Vincent Ganu2, Ernest Amaning-
Kwarteng2, John Tetteh1,2 and C. Charles Mate-Kole1,2
1University of Ghana, Accra, Greater Accra, Ghana. 2Korle-Bu Teaching Hospital, Accra, Greater Accra,
Ghana.
ABSTRACT
BACKGROUND: Apart from increasing the risk of tuberculosis (TB), diabetes may be associated with more severe disease and lower rates of
sputum conversion among TB patients.
METHODS: We conducted a baseline cross-sectional study with a longitudinal follow-up of newly diagnosed smear-positive TB patients for 6
months. Sputum conversion rates between those with dysglycemia and those without were compared at 2 months (end of the intensive
phase) and 6 months (end of the treatment). Descriptive statistics and logistic regression were computed to assess factors associated with dys-
glycemia as well as sputum conversion.
RESULTS: A significantly higher proportion of normoglycemic patients had negative sputum compared with those with dysglycemia (83% vs
67%, P-value< .05) at 2 months but not at 6 months (87% vs 77%, P-value> .05). After controlling for age group and adjusting for other covariates,
patients with dysglycemia were 66% less likely to convert sputum than those with normoglycemia. Females were at least 7 times more likely than
males and those with high waist-to-hip ratio (WHR) of 88% were less likely compared with those with low WHR for sputum conversion at 2 months,
respectively. At 6 months, females (compared with males) and those with high WHR (compared with those with normal WHR) were at over 9 times
increased odds and 89% less likely for sputum conversion, respectively.
CONCLUSION: A significantly lower proportion of smear-positive TB patients with dysglycemia converted to smear negative after 2 months of
treatment but not at the end of the treatment, thus suggesting a transient impact of dysglycemia on sputum conversion.
KEYWORDS: Tuberculosis, smear Positive, dysglycemia, sputum Conversion, transient.
RECEIVED: April 21, 2021. ACCEPTED: July 26, 2021 DECLARATION OF CONFLICTING INTERESTS: The authors declared no potential conflicts
of interest with respect to the research, authorship, and/or publication of this article.
TYPE: Original Research Article
CORRESPONDING AUTHOR: Ernest Yorke, Department of Medicine and Therapeutics,
FUNDING: The authors disclosed receipt of the following financial support for the research, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, P.O. Box
authorship, and/or publication of this article: This work was supported by the University of GP 4236, Legon, Accra, Ghana. Email: pavlovium@yahoo.com
Ghana Office of Research, Innovation and Development (ORID) grant (Grant no. URF/9/
ILG-076/2015-2016).
1. Introduction phase) and 6 months (end of the treatment)9,12 while others
Worldwide, tuberculosis (TB) infections are still high despite have shown no relationship between diabetes and sputum
the many strategies to curtail it. In 2016, there were an esti- conversion rate at the end of the secondmonth.14,17 More
mated 10.4 million new TB cases worldwide with about 1.7 data are needed to help ascertain the impact of dysglycemia
million people dying from it, making it the topmost infectious on the sputum conversion rate among TB patients. The add-
killer.1 With the high global burden of diabetes and an itional information would help determine if adjustments must
increasing trend, especially in type 2 diabetes, the recognized be made to the current treatment regime. Thus, the present
reciprocal negative impact of TB and diabetes on each other is study ascertained the impact of dysglycemia on sputum con-
likely to worsen.2–4 Diabetes represents a significant popula- version among smear-positive TB patients in a tertiary care
tion risk for TB infections of ∼1.5 to 7.8 times5–8 and may setting.
also be related to the development of multidrug resistant
TB with an odds ratio (OR) of 2.1.9 Diabetes may be asso-
ciated with more severe disease, higher rates of reactivation 2. Materials and Methods
of old TB foci, more cavitations, and higher risk of death 2.1 Study Design and Site
among TB patients.6,9–11 The relationship between rates of The study adopted a cross-sectional baseline assessment with a
sputum conversion among TB patients with diabetes or dys- longitudinal follow-up for 6 months at the outpatient referral
glycemia appears inconsistent.9,12–16 Some studies have sug- chest clinic of the Korle-Bu Teaching Hospital, which is a ter-
gested a reduced rate at 2 months (end of the intensive tiary care facility in Ghana.
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2 Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine
2.2 Participants and Sampling 6.1 mmol/L and 7.8 mmol/L respectively are normal.
Diagnoses of impaired or borderline fasting and glucose toler-
We consecutively enrolled patients who were either first diag-
ance were made when FPG and 2HPP values were 6.1 to
nosed at or referred to the Korle-Bu chest clinic as newly diag-
6.9 mmol/L and 7.8 to 11 mmol/L, respectively.24 None of
nosed smear-positive TB patients. Included patients were those
the participants was known to have diabetes prior to enroll-
aged 18 years or older, had no previous TB treatment, and who
ment. Patients found to have diabetes were referred to receive
gave informed written consent. Patients who were diagnosed
appropriate care.
with smear-negative TB or extrapulmonary TB, those who
The presence of Mycobacterium tuberculosis (MTB) was
had previously been treated for TB, or refused to give informed
tested using the Cepheid GeneXpert system, a rapid,
consent were excluded from the study.
nucleic acid amplification test (NAAT) through polymerase
Differences in sputum culture conversion rates comparing
chain reaction to confirm the diagnosis. Sputum smear
pulmonary TB patients with and without diabetes mellitus
microscopy using Ziehl–Neelsen staining was however used
(DM) from previous studies have varied between zero and
18–22 to ascertain sputum conversion at 2 months (end of the inten-15%. Assuming a 15% difference in sputum conversion
sive phase) and 6 months (end of the treatment). The sputum
rates between pulmonary TB patients with or without DM,
conversion rate was determined as the percent of enrolled
134 smear-positive TB patients would be adequate to detect
smear-positive pulmonary TB cases that converted to smear-
a difference in sputum conversion based on a power of 80%
negative status at 2 months and 6 months. For the purposes
and a 2-sided confidence interval (CI) of 90%. Sampling
of analyses, participants with “very low” and “low” detected
was done on weekdays for 16 months until a sample size of
MTB and those with “medium” and “high” detected MTB
200 was obtained of which 171 had complete data.
by GeneXpert were recategorized as low and high loads,
Anti-TB treatment regimen used included a combination of
respectively.
rifampicin (R), isoniazid (H), pyrazinamide (Z) and etham-
Body mass index (BMI) was calculated and categorized as
butol (E) for the intensive phase (first 2 months) while
obese, overweight, normal, and underweight based on the
only rifampicin (R) and isoniazid (H) were used in the con-
cut-offs of 30.0 or more, 25 to 29.9, 18.5 to 24.9, and <18.5
tinuation phase (next 4 months). None of the recruited par-
(kg/m2), respectively.25
ticipants admitted to being a known diabetic prior to the
study.
The center employs the directly observed therapy strategy 2.4 Statistical Analysis
(DOTS) to improve compliance to treatment. Moreover, the
Data were analyzed with the statistical software Stata version 15
TB control program employs treatment supporters to help
after initial capture with Microsoft Excel 2010. Analyses for the
patients adhere to their treatment in the community. They
various characteristics were performed for patients with com-
pay visits and assess compliance to treatment; challenges iden-
plete data. For the purposes of analyses, patients were categor-
tified are remedied. This ensures a high rate of compliance to
ized as either dysglycemia or abnormal (impaired glucose
medications and successful treatment outcomes.
tolerance and diabetes) or normal using 2HPP values.
Sociodemographic, anthropometric, and clinical variables
2.3 Measurements
were summarized and compared between these two groups
Patients enrolled were given a data abstraction tool to capture using the χ2 test. A similar analysis using FPG was not per-
data concerning their sociodemographic and anthropometric formed due to the very few numbers involved.
characteristics as well as medical history. Two approaches of statistical analysis were performed
To assess their glycemia status, a 75 g oral glucose tolerance involving the descriptive χ2 test and logistic regression analysis.
test (OGTT) was administered to all patients. A 10 mL fasting Descriptive cross-tabulation analysis was performed to assess
blood sample was taken into fluoridated blood sample tubes covariates significantly associated with 2HPP using the χ2
(kept on ice and centrifuged within 15 min of blood draw), test. Due to the dummy nature of our study outcomes, a
ethylene-diamine-tetra-acetic acid (EDTA) tubes, and plain binary logistic regression model was used to test the effect of
tubes.23 Patients then received 75 g of glucose in 250 mL of sociodemographic, clinical, and lifestyle factors on 2HPP and
water, and after–2-h blood sample was taken into fluoridated sputum conversion separately. Logistic regression analysis was
sample tubes and processed similarly as the fasting sample. conducted to estimate factors significantly influencing 2HPP.
Plasma glucose was determined using glucose oxidase commer- Age group as the only significant factor influencing 2HPP
cial reagent kits and controls (Diasys GmBH, Germany). was controlled and other covariates were adjusted in further
Diabetes was diagnosed when the fasting plasma glucose analysis to quantify the impact of 2HPP on sputum conversion
(FPG) and the 2-h postprandial (2HPP) blood glucose level for 2 months and 6 months separately by adopting logistic
were >7 mmol/L and >11.1 mmol/L, respectively, or on regression. The statistical tests were set at the 5% significance
regular medication for diabetes. FPG and 2HPP values below level.
Yorke et al. 3
3. Results Table 1. Sociodemographic, lifestyle, and clinical characteristics
3.1 Participant Characteristics associated with 2HPP among TB patients
The ages of the participants were evenly distributed across the 2HPP CATEGORY
age groups with a mean age of 38.2± 13.6 years (range 18–75
years). The majority of participants (74.8%) were educated up ABNORMAL NORMAL TOTAL
to senior high/ordinary level (SHS/O level) and 68.2% were DEMOGRAPHIC
2
underweight. Males represented 78.9% of the study partici- CHARACTERISTICS N (%) N (%) N χ
pants. The test of association suggests that 2HPP is associated Age group (years) 171 10.29*
with only age group and educational level (P-value < .05). The 18 to 24 8 (22.2) 28 (77.8) 36
result shows that generally, the proportion of participants
with abnormal 2HPP increases with age, the highest seen 25 to 34 13 (31.0) 29 (69.0) 42
among the middle-age group 45 to 54 (54.5%). Also, the pro- 35 to 44 15 (48.4) 16 (51.6) 31
portion of participants with dysglycemia with a low sputum 45 to 54 18 (54.5) 15 (45.5) 33
load was 19.4% compared to 20% in the case of normoglycemic
patients whereas 80.6% and 79.8% of participants with high 55 to 64 13 (44.8) 16 (55.2) 29
sputum load were dysglycemic and normoglycemic, respect- Sex 171 0.65
ively. These marginal differences did not show any significant Male 55 (40.7) 80 (59.3) 135
differences. Full details of the demographic characteristics are
shown in Table 1. Female 12 (33.3) 24 (66.7) 36
Marital status 171 1.24
3.2 Glycemic Variables of Participants Married 30 (40.0) 45(60.0) 75
Single 32 (36.8) 55 (63.2) 87
Of a total of 171 participants, using FPG values 87.1%, 8.8%,
and 4.1% had normal glucose, impaired fasting, and diabetes, Separated/divorced 5 (55.6) 4 (44.4) 9
respectively. Using 2HPP values, 61.4%, 27.5%, and 11.1% Educational level 171 9.65*
had normal glucose, impaired glucose tolerance, and diabetes,
None 5 (33.3) 10 (66.7) 15
respectively. The combined prevalence of dysglycemia was
thus 12.9% (n= 22) and 38.6% (n= 66) using fasting glucose Primary 6 (37.5) 10 (62.5) 16
and 2HPP values, respectively, as shown in Table 2. Middle/JHS 34 (54.0) 29 (46.0) 63
SHS/O level 14 (28.6) 35 (71.4) 49
3.3 Predictors of Abnormal Glucose Patterns Among Study Tertiary 8 (28.6) 20 (71.4) 28
Participants Employment status 170 1.79
Factors influencing the development of abnormal glucose were No 13 (30.2) 30 (69.8) 43
explored using binary logistic regression. Being aged 45 to 54
Yes 53 (41.7) 74 (58.3) 127
years had 6.43 increased odds (P-value= .007) for developing
abnormal glucose compared to the reference age of 18 to 24 Smoking status 168 0.08
years. There were no other significant predictors of abnormal Yes 5 (35.7) 9 (64.3) 14
glucose values as shown in Table 3.
No 61 (39.6) 93 (60.4) 154
Alcohol intake 167 0.77
3.4 Comparison of Sputum Conversion Rates at 2 and 6
Yes 9 (32.1) 19 (67.9) 28
Months
No 57 (41.0) 82 (59.0) 139
The sputum status was assessed and compared to determine the
sputum conversion rates at 2 and 6 months. At 2 months, a sig- BMI 157 1.78
nificantly higher proportion of normoglycemic subjects had Below 18.5 45(42.1) 62 (57.9) 107
negative sputum compared with those with dysglycemia (83% (underweight)
vs 67%) (Z-test=−2.5; P < .05). Despite the proportionally 18.5 to 24.9(normal) 15 (33.3) 30 (66.7) 45
higher numbers of the dysglycemia group that maintained 25 to 29.9 (overweight) 1 (20.0) 4 (80.0) 5
sputum conversion at 6 months, there was no statistical differ-
ence between the 2 groups (87% vs 77%, Z-test=−1.71, P > Systolic BP 170 0.88
.05), as shown in Table 4. (continued)
4 Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine
Table 1. Continued. Table 3. Factors influencing abnormal glycaemia among TB patients
2HPP CATEGORY 95% CONF.
INTERVAL
ABNORMAL NORMAL TOTAL
DEMOGRAPHIC COVARIATES AOR P-VALUE LOWER UPPER
CHARACTERISTICS N (%) N (%) N χ2 Age group
Normal 43 (39.8) 65 (60.2) 108 18 to 24 Ref
Elevated 16 (34.0) 31 (66.0) 47 25 to 34 1.66 .398 0.51 5.38
Hypertension 7 (46.7) 8 (53.3) 15 35 to 44 3.27 .076 0.88 12.12
Diastolic BP 170 0.21 45 to 54 6.43 .007* 1.66 24.86
Normal 59 (39.3) 91 (60.7) 150 55 to 64 2.90 .144 0.70 12.11
Elevated 5 (33.3) 10 (66.7) 15 Sex
Hypertension 2 (40.0) 3 (60.0) 5 Male Ref
Waist–hip ratio 171 0.28 Female 0.80 .767 0.18 3.50
Low 55 (40.1) 82 (59.9) 137 Marital status
Moderate 5 (35.7) 9 (64.3) 14 Married Ref
High 7 (35.0) 13 (65.0) 20 Single 1.34 .504 0.57 3.19
Sputum load (2HPP) 171 0.016 Separated/divorced 1.10 .900 0.24 5.07
Low Load 13 (19.4) 21 (20.2) 34 Educational level
High Load 54 (80.6) 83 (79.8) 137 None Ref
*P< .05. Primary 1.66 .586 0.27 10.26
Abbreviations: 2HPP, 2-hour post-prandial glucose; TB, tuberculosis; BP, blood
pressure; BMI, body mass index; SHS, senior high school; Middle/Junior High School 3.25 .125 0.72 14.68
Senior High School/O-level 1.08 .926 0.22 5.18
3.5 Predictors of Sputum Conversion at 2 and 6 Months
Tertiary 1.02 .977 0.20 5.30
Binary logistic regression models were used to test the effect of Employment status
sociodemographic, clinical, and lifestyle factors on the treat-
ment (sputum conversion) (Table 5). After controlling for No Ref
demographic factors and adjusting for age groups, the following Yes 2.26 .052 0.99 5.14
Smoking status
Table 2. Glycaemic variables of study participants
Yes Ref
VARIABLE FREQUENCY (N ) PROPORTION (%)
No 0.59 .460 0.14 2.40
Fasting Plasma Glucose (mmol/L)
Alcohol intake
(Mean±SD) 5.21± 1.46
Yes Ref
Normal (<6.1) 149 87.1
No 0.56 .299 0.18 1.68
Impaired/borderline (6.1–7) 15 8.8
Systolic BP
Diabetes (>7.1) 7 4.1
Normal Ref
2 HPP Glucose (mmol/L)
Elevated 1.05 .901 0.47 2.37
(Mean±SD) 8.24± 3.26
Hypertension 1.41 .663 0.30 6.61
Normal (<6.1) 105 61.4
Diastolic BP
Impaired/borderline (6.1–7) 47 27.5
Normal Ref
Diabetes (>7.1) 19 11.1
(continued)
Abbreviation: 2-HPP, 2-hour post-prandial glucose.
Yorke et al. 5
Table 3. Continued. Table 5. 2HPP influence on treatment outcome (sputum conversion)
among TB patients adjusting for demographic factors and controlling for
95% CONF. age group
INTERVAL
PERIOD OF TREATMENT OUTCOME
COVARIATES AOR P-VALUE LOWER UPPER
2 MONTHS 6 MONTHS
Elevated 0.42 .250 0.09 1.86
Hypertension 0.49 .517 0.06 4.26 Covariates AOR (95% CI) P-VALUE AOR (95% CI) P-VALUE
Waist-to-hip ratio Two HPP
Low Ref Normal Ref Ref
Moderate 0.98 .978 0.18 5.17 Abnormal 0.34 (0.14–0.82) .018 0.46 (0.17–1.25) .128
High 0.90 .900 0.19 4.39 Sex
*P< .05. Male Ref Ref
Abbreviations: aOR, adjusted odds ratio; TB, tuberculosis; SHS/O level, senior
high school/ordinary level. Female 7.44 (1.73–32.0) .007 9.29 (1.78–48.5) .008
Marital status
Table 4. Test of proportion showing the differences in negative sputum Married Ref Ref
test result between TB patients subjects with abnormal glucose and
those with normal glucose (using 2HPP) at two and six months (n= 171) Single 1.47 (0.64–to 3.41) .363 1.75 (0.06–4.52) .249
2 MONTHS 6 MONTHS Separated/ 0.41 (0.08–1.91) .254 0.42 (0.06–2.81) .369
divorced
2 HPP PROPORTION (95% CI) PROPORTION (95% CI) Educational level
Abnormal 67.16 (55.92–78.41) 77.61 (67.63–87.59) None Ref Ref
Normal 83.65 (76.55–90.76) 87.5 (81.14–93.85) Primary 0.44 (0.08–2.49) .358 0.74 (0.08–6.46] .785
Z-statistic −2.51* −1.71 Middle/Junior 1.19 [(0.25–5.36) .826 3.82 (0.57–25.52) .166
High School
*P-value< .05.
Abbreviations: 2HPP, 2-hour post-prandial glucose; TB, tuberculosis Senior High 0.84 (0.18–3.82) .819 2.00 (0.33–12.14) .453
School/O-level
Tertiary 0.72 (0.15–3.37) .679 0.72 (0.13–4.04) .713
factors were associated with sputum conversion at 2 months:
subjects with dysglycemia were 66% less likely than those Employment status
with normoglycemia (OR (adjusted odds ratio (aOR)), [95% No Ref Ref
confidence interval (CI)], P-value: 0.34, [0.14–0.82], .018);
Yes 1.27 (0.50–3.21) .619 0.22 (0.04–1.14) .072
females were 7.44 times more likely than men (aOR, [95%
CI], P-value: 7.44, [1.73–32.0], .007); and those with high Smoking status
WHR were 88% less likely compared with those with low Yes Ref Ref
WHR (aOR, [95% CI], P-value: 0.12, [0.02–0.54], .006) to
No 0.49 (0.08–2.91) .435 1.94 (0.31–12.27) .482
convert sputum, respectively. At 6 months and after similar
adjustments, females (compared with males) and high WHR Alcohol intake
(compared with those with normal WHR) were 9.29 times Yes Ref Ref
more likely (aOR, [95% CI], P-value: 7.44, 9.29 [1.78–48.5], No 1.67 (0.50–5.58) .401 2.21 (0.26–5.57) .809
.008] and 89% less likely (aOR, [95% CI], P-value: 0.11,
[0.02–0.63], .013) for sputum conversion, respectively. Waist-to-hip ratio
Low Ref Ref
Moderate 0.48 (0.09–2.44) .374 0.81 (0.11–5.95) .837
4. Discussion
The results of the study show that at 2 months, a significantly High 0.12 (0.02–0054) .006 0.11 (0.02–0.63) .013
higher proportion of normoglycemic subjects had negative Abbreviations: 2HPP, 2-hour post-prandial glucose; aOR, adjusted odds ratio;
sputum compared with those with dysglycemia. However, SHS, senior high school TB, tuberculosis
6 Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine
despite the proportionally higher numbers of the normogly- include low incomes, the load of the bacilli, malnutrition, exces-
cemia group that maintained sputum conversion at 6 months, sive alcohol use, overcrowding, smoking, HIV infection, dia-
there was no statistical difference between the 2 groups. This betes, drugs that cause immunosuppression, and closeness to
suggests a transient impact of dysglycemia on sputum conver- a person with active TB.1,5–36
sion among TB patients. While some studies have supported The increased risk of the age group 45–54 years with abnor-
the negative impact of diabetes on sputum conversion through- mal blood glucose (aOR, 6.43) may represent an increased
out the period of TB treatment, others have showed a transient inherent risk for dysglycemia and type 2 diabetes conferred by
impact.9,11,12 Alisjahbana et al. reported that TB patients who increasing age.38 Subjects with high WHR were less likely to
were diabetic had significantly higher percent of smear-positive convert sputum compared with those with normal WHR
results than their nondiabetic counterparts at 2 months (18.1% both at 2 and 6 months. High WHR is a risk factor for dysgle-
vs 10.0%). Unlike our study, after 6 months (end of the treat- mia and diabetes,39 which influences the development of
ment), 22.2% of sputum specimens from diabetic patients reduced clearance of TB pathogens as described earlier
were positive for M tuberculosis ( aOR, 7.65; P= .004).9 In a on.30,31 This association is also independent of age, family
retrospective study that assessed TB patients with self-reported history of diabetes, and sex;39 the sex association is stronger
diabetes from south Texas (USA) and north-eastern Mexico, in women than men.39 Central obesity as measured by para-
the authors reported that TB patients were more likely to meters such as WHR, waist circumference (WC), and BMI
remain positive at the end of the first (Texas cohort) or has been associated with impaired glucose–insulin homeostasis
second (Mexico cohort) month of treatment,12 which was and insulin clearance, decreased insulin-stimulated glucose dis-
similar to our study. A systematic review published in 2011 posal finally which leads to decreased glucose tolerance.40
by Baker et al. reported an increased risk of relapse in these It is not clear why females were more likely to convert
patients (relative risk, 3.89; 95% CI, 2.43–6.23). Unlike our sputum than male counterparts both at 2 and 6 months. It
study, some studies have however shown no relationship must, however, be stated that females are more likely than
between diabetes and sputum conversion rate at the end of men to be compliant with their treatment and also keep their
month 2,13,16,17 while a trend toward increased time to appointments, which may in turn improve treatment
sputum conversion has rather been found in other outcomes.41,42
studies.15,26,27
The transient impact of dysglycemia on sputum conversion 5. Conclusion
rate suggests possible nonlasting pathophysiological linkages
28,29 This study has added to the body of knowledge on the impact ofand putative mechanisms. The risk of TB patients with
dysglycemia on sputum conversion among TB patients. A sig-
diabetes for reduced sputum conversion rate is suggested puta-
nificantly lower proportion of smear-positive TB patients with
tively due to the reduced numbers as well as the function of T
dysglycemia converted to smear negative after 2 months of
lymphocytes involved in T-helper cells 1(TH1) cytokine inhib-
30,31 treatment but not at the end of treatment suggesting a transientition of M tuberculosis. In diabetes, dysfunction of macro-
impact of dysglycemia on sputum conversion. Other factors,
phages occurs, which impairs phagocytic and chemotactic
including age, female sex, and increased WHR, have shown
function as well as the production of reactive oxygen
30,31 association. Larger studies are needed to validate these findings.species. Further, the impairment of chemotaxis of mono-
A change in the current TB regimen is not recommended based
cytes is thought to occur in diabetes.32 The respiratory burst
on our findings.
used in expelling pathogens is also thought to be impaired
30,31 Future research is required in this field and must comparewith diabetes.
the severity of TB presentation between the dysglycemia and
TB on its own has been linked to the development of
28,33 normoglycemic groups, such as symptom burden, pattern ofimpaired glucose tolerance (IGT) and new-onset dia-
28,34 lobe involvement, reactivation of old foci, rates of hemoptysis,betes. While IGT generally normalizes after TB has been
fever, and atypical presentations and cavitations. We plan to
treated, the risk of developing type 2 diabetes in the future
35 perform formal glucose tolerance tests at 2 months (end ofremains high. Some other studies revealed that between
the intensive phase) and at 6 months (end of the treatment)
19% to 42.6% of active TB patients, who were discovered to
to confirm whether dysglycemia associated with TB is transient.
have IGT or diabetes, had significant reduction or complete
Patients would also be followed up to ascertain the RRs
regression in the rates after treatment.28,29 This suggested
between the two groups.
stress response to infection leading to dysglycemia is thought
to be due to the elaboration of interleukin 1 (IL-1), interleukin
6 (IL-6), and tumor necrosis factor-alpha.5,35 Acknowledgments
Unsurprisingly in our study, most participants were young, We also appreciate the contribution of Ama Aidoo, Norah
male, and single; those are well-known sociodemographic char- Nkornu, and Kelvin Acquaye, especially in data collection.
acteristics of TB patients.1,36,37 Other risk factors for TB Data Availability Statement
Yorke et al. 7
The data that support the findings of this study are available 14. Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two
epidemics. Lancet Infect Dis. 2009;9(12):737–746.
from the corresponding author upon request 15. Gautam S, Shrestha N, Mahato S, Nguyen TP, Mishra SR, Berg-Beckhoff G.
Diabetes among tuberculosis patients and its impact on tuberculosis treatment in
South Asia: a systematic review and meta-analysis. Sci Rep. 2021;11(1):1–12.
Author Contributions 16. Kameda K, Kawabata S, Masuda N. Follow-up study of short course chemotherapy
EY conceived the study, participated in its design, data collec- for pulmonary tuberculosis complicated with diabetes mellitus. Kekkaku
tion, analysis, and drafted the manuscript and collation of all (Tuberculosis). 1990;65(12):791–803.17. Singla R, Khan N, Al-Sharif N, Al-Sayegh MO, Shaikh MA, Osman MM.
drafts. VB, IDD, VG, MBAM, EKA, JT, and CCM contrib- Influence of diabetes on manifestations and treatment outcome of pulmonary TB
uted to the study design, data collection, analysis, and writing patients. Int J Tuberc Lung Dis. 2006;10(1):74–79.
18. Cheng J, Zhang H, Zhao YL, Wang LX, Chen MT. Mutual impact of diabetes
the manuscript draft. All authors read and approved the final mellitus and tuberculosis in China. Biomed Environ Sci. 2017;30(5):384–389.
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diabetes-related comorbidities on pulmonary tuberculosis. PloS one. 2015;10(3):
e0121698
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among tuberculosis patients under DOTS strategy in Egypt. East Mediterr Health
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number URF/9/ILG-076/2015 to 2016. It complied with the 22. Singla R, Osman M, Khan N, Al-Sharif N, Al-Sayegh M, Shaikh M. Factors pre-
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Strict con dentiality of data and privacy for study participants Guidelines and recommendations for laboratory analysis in the diagnosis and man-fi agement of diabetes mellitus. Clin Chem. 2002;48(3):436–472.
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8 Clinical Medicine Insights: Circulatory, Respiratory and Pulmonary Medicine
41. Manteuffel M, Williams S, Chen W, Verbrugge RR, Pittman DG, Steinkellner A. United Kingdom. He has been extensively involved in the organization
Influence of patient sex and gender on medication use, adherence, and prescribing and also served as a facilitator to numerous metabolic and cardiovascular
alignment with guidelines. J Womens Health. Feb 2014;23(2):112–119. doi:10.
1089/jwh.2012.3972 Continuing Medical Education programs, both locally and abroad. He
42. Rodriguez Pacheco R, Negro Alvarez JM, Campuzano Lopez FJ, et al. values the use of practical tools as well as new technology in research
Non-compliance with appointments amongst patients attending an allergology and development to solve problems and also to advance knowledge.
clinic, after implementation of an improvement plan. Allergol Immunopathol He has served as a consultant and Advisory Board member for a
(Madr). Jul-Aug 2007;35(4):136–144. number of multinational pharmaceutical companies involved in dia-
betes care, both locally and abroad. His main research interests
Author Biography include diabetes and kidney disease, psychological impact of diabetes,
pregnancy outcomes in diabetes, and diabetic foot care as well as
Ernest Yorke, FWACP, FGCP, MSc, Diabetes (Cardiff), MSc, thyroid diseases. He has over 30 peer-reviewed publications to his
Endo. (UK), MB ChB, BSc, Cert. HAM (Ghana Institute of credit. He has other interests outside clinical work and academia.
Management and Public Administration, GIMPA). Dr Ernest Among many other volunteer works, he is currently the Chairman of
Yorke is a fellow of the West African College of Physicians and the the Greater Accra Division of the Ghana Medical Association and
Ghana College of Physicians & Surgeons. Currently, he is a senior lec- also a Board member of Diabetes Youth Care, a non-governmental
turer at the University of Ghana Medicine School, and a consultant organization dedicated to the care and well-being of young people
physician/endocrinologist at the Korle-Bu Teaching Hospital, Accra. living with diabetes in Ghana. He is married with three children and
He also holds double Masters’ degrees from universities from the watches TV in his spare time.