Factors Associated with Pulmonary Tuberculosis among Diabetic Patients in Ban Fang Hospital, Khon Kaen Province

Authors

  • Paramee Trakulkajornsak Ban Fang Hospital
  • Pattapong Kessomboon Department of Community Medicine, Faculty of Medicine, Khon Kaen University

Keywords:

เบาหวาน วัณโรคปอด; ค่าระดับน้ำตาลในเลือดหลังอดอาหาร, Diabetes Mellitus type 2; pulmonary tuberculosis; fasting blood sugar

Abstract

Background and Objective:  Poor control diabetic patients are at risk of various infections including tuberculosis (TB). This study aimed at studying factors associated with pulmonary tuberculosis infection in diabetic patients

Method: An unmatched case-control study was conducted among type 2 diabetes mellitus (T2DM) patients in Ban Fang hospital, Khon Kaem from October 1st, 2012 to April 30th, 2019. The study group included all T2DM patients who were diagnosed with pulmonary TB, where as the control group were T2DM patients without pulmonary TB diagnosis. Subjects in control group were randomly selected into a ratio 1:2 of case per control. Data collections were performed by reviewing medical records of the hospital database. Data were analyzed using descriptive and analytic approaches such as frequency, percentage, Pearson Chi-square test, Independent-Samples T-test, Odds ratio and multiple logistic regression.

Results: A total of 210 subjects were selected comprising 68 cases of study groupand 142 case of control group. The factors which were significantly related to pulmonary TB among diabetic patients included:  FBS ≥180 mg/dl (Adjusted OR = 5.63, 95% CI: 2.61-12.16); BMI<23 kg/m2 (Adjusted OR = 4.86, 95% CI: 2.18-10.84); receiving insulin injection (Adjusted OR = 0.31, 95% CI: 0.13-0.74) and male (Adjusted OR = 2.28, 95% CI: 1.06-4.88).

Conclusion: T2DM patients with high FBS, normal or low BMI and male gender were at high risk of pulmonary TB infection, while patients with history of taking insulin injection were at lower risk.

References

1. World Health Organization. Diabetes [Internet]. [cited Jun 16, 2019]. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes
2. Kalofoutis C, Piperi C, Kalofoutis A, Harris F, Phoenix D, Singh J. Type II diabetes mellitus and cardiovascular risk factors: Current therapeutic approaches. Exp Clin Cardiol 2007; 12: 17–28.
3. Strain WD, Paldánius PM. Diabetes, cardiovascular disease and the microcirculation. Cardiovasc Diabetol 2018; 17: 57.
4. Jeon CY, Murray MB. Diabetes Mellitus Increases the Risk of Active Tuberculosis: A Systematic Review of 13 Observational Studies. Williams B, editor. PLoS Med 2008; 5: e152.
5. Martinez N, Kornfeld H. Tuberculosis and diabetes: from bench to bedside and back. Int J Tuberc Lung Dis 2019; 23: 669-77.
6. World Health Organization. Tuberculosis (TB) in Thailand [Internet]. SEARO. [cited Jun 16, 2019]. Available from: http://www.searo.who.int/thailand/areas/tuberculosis/en/
7. กองวัณโรค. แผนยุทธศาสตร์วัณโรคระดับชาติ พ.ศ. 2560 – 2564. กรมควบคุมโรค กระทรวงสาธารณสุข. [Internet]. [cited Jun 21, 2020]. Available from: https://tbthailand.org/
8. Nguyen CH, Pascopella L, Barry PM. Association between diabetes mellitus and mortality among patients with tuberculosis in California, 2010-2014. Int J Tuberc Lung Dis 2018; 22: 1269-76.
9. Oluboyo PO, Erasmus RT. The significance of glucose intolerance in pulmonary tuberculosis. Tubercle 1990; 71: 135–8.
10. Moutschen M, Scheen A, Lefèbvre P. Impaired immune responses in diabetes mellitus: Analysis of the factors and mechanisms involved. Relevance to the increased susceptibility of diabetic patients to specific infections. Diabete Metab 1992; 18: 187-201.
11. กิตศราวุฒิ ขวัญชารี, พรนภา ศุกรเวทย์ศิริ, กรรณิการ์ ตฤณวุฒิพงษ์. ปัจจัยที่มีความสัมพันธ์กับการป่วยวัณโรคปอดเสมหะพบเชื้อในผู้ป่วยเบาหวาน ของประเทศไทย: การวิเคราะห์เมตา. วารสารวิชาการ สำนักงานป้องกันควบคุมโรคที่ 7 จังหวัดขอนแก่น 2016; 23: 1–11.
12. American Diabetes Association. Glycemic Targets: Standards of Medical Care in Diabetes 2019. Diabetes Care 2019; 42 (Suppl 1): S61–70.
13. Akbari M, Hassan-Zadeh V. Hyperglycemia Affects the Expression of Inflammatory Genes in Peripheral Blood Mononuclear Cells of Patients with Type 2 Diabetes. Immunol Invest 2018; 47: 654-65.
14. สมาคมโรคเบาหวานแห่งประเทศไทย. แนวทางเวชปฏิบัติสำหรับโรคเบาหวาน 2560. Clinical Practice Guideline for Diabetes 2017 [Internet]. [cited Jan 31, 2020 ]. Available from: https://www.dmthai.org/index.php/knowledge/healthcare-providers/cpg/443-guideline-diabetes-care-2017
15. Soh AZ, Chee CBE, Wang Y-T, Yuan J-M, Koh W-P. Diabetes and body mass index in relation to risk of active tuberculosis: a prospective population-based cohort. Int J Tuberc Lung Dis. 2019; 23: 1277–82.
16. Papier K, D’Este C, Bain C, Banwell C, Seubsman S, Sleigh A, et al. Body mass index and type 2 diabetes in Thai adults: defining risk thresholds and population impacts. BMC Public Health. 2017; 17: 707.
17. Alwarawrah Y, Kiernan K, MacIver NJ. Changes in Nutritional Status Impact Immune Cell Metabolism and Function. Front Immunol. 2018; 16: 1055.
18. Dobler CC, Flack JR, Marks GB. Risk of tuberculosis among people with diabetes mellitus: an Australian nationwide cohort study. BMJ Open 2012; 2: e000666.
19. Boucot KR, Dillon ES, Cooper DA, Meier P, Richardson R. Tuberculosis among diabetics: the Philadelphia survey. Am Rev Tuberc 1952; 65: 1–50.
20. จตุพร ฤกษ์ตระกูล, พรนภา ศุกรเวทย์ศิริ. ปัจจัยที่มีความสัมพันธ์กับการป่วยเป็นวัณโรคปอด ในผู้ป่วยเบาหวาน ภาคตะวันออกเฉียงเหนือ ประเทศไทย. วารสารวิชาการ สำนักงานป้องกันควบคุมโรคที่ 7 จังหวัดขอนแก่น 2019; 26: 1–12.
21. Wang S, Ungvari GS, Forester BP, Chiu HFK, Wu Y, Kou C, et al. Gender differences in general mental health, smoking, drinking and chronic diseases in older adults in Jilin province, China. Psychiatry Res 2017; 251: 58-62.
22. Short SE, Yang YC, Jenkins TM. Sex, gender, genetics, and health. Am J Public Health 2013; 103 (Suppl 1): S93-101.
23. Ji Y, Cao H, Liu Q, Li Z, Song H, Xu D, et al. Screening for pulmonary tuberculosis in high-risk groups of diabetic patients. Int J Infect Dis 2020; 93: 84-9.

Published

2020-09-08

How to Cite

1.
Trakulkajornsak P, Kessomboon P. Factors Associated with Pulmonary Tuberculosis among Diabetic Patients in Ban Fang Hospital, Khon Kaen Province. SRIMEDJ [Internet]. 2020 Sep. 8 [cited 2024 Dec. 24];35(5):523-30. Available from: https://li01.tci-thaijo.org/index.php/SRIMEDJ/article/view/246670

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Section

Original Articles