Prevalence Of Diabetes Mellitus Among Tuberculosis Patients Registered Under Revised National Tuberculosis Control Programme

Abstract

Introduction India has the highest burden of tuberculosis accounting for one fifth of the global incidence with an annual estimate of approximately 2 million cases. Global tuberculosis control is being undermined by the growing number of patients with diabetes mellitus. There are around 36 million diabetics in India which is estimated to increase to 80 million by 2030. Active detection of diabetes amongst tuberculosis patients may provide an opportunity to identify previously undiagnosed diabetes, to offer optimum diabetic care and improve the treatment outcomes of tuberculosis. Objectives To find the prevalence of diabetes mellitus among tuberculosis patients registered under Revised National Tuberculosis Control Programme and to compare the socio demographic and clinical profile of patients with tuberculosis and diabetes mellitus with that of tuberculosis alone. Methodology A cross sectional study was done for one complete year in three primary health centres - Handignoor, Vantamuri, Kinaye ; three urban health centres- Ram Nagar, Asok Nagar, Rukmini Nagar and in Revised National Tuberculosis Control Programme unit, Government District Hospital Belgaum. A total of 437 tuberculosis patients were enrolled in the study. Patients were first screened with fasting blood glucose and later diagnosis of diabetes mellitus was confirmed with oral glucose tolerance test. Results In the present study the prevalence of DM among TB patients was found to be 21.1% of which one third of the cases were newly diagnosed. On comparison of socio-demographic and clinical profile of patients of TB-DM with that of TB, the study observed significant difference between the two groups with respect to age group commonly affected (41-70 years vs 21-40 years), male: female ratio (3:1 vs 1.9:1), highly symptomatic at presentation (85% vs 56%), higher body mass index (17.4% vs 5.5%), greater waist circumference in males and females, pulmonary form of tuberculosis (90.2% vs 82.6%), high bacterial load of ++/+++ (57.6% vs 28.6%), relapse and failure cases (17.6% vs 8.4%) and HIV positivity (27.5% vs 12.8%). Conclusion The high prevalence of diabetes among tuberculosis patients may adversely affect the outcome of tuberculosis treatment. Hence screening of all tuberculosis patients for diabetes must be routinely done.