Impact of diabetes on treatment outcomes and long-term survival in multidrug-resistant tuberculosis

Young Ae Kang, Song Yee Kim, Kyung Wook Jo, Hee Jin Kim, Seung Kyu Park, Tae Hyung Kim, Eun Kyung Kim, Ki Man Lee, Sung Soon Lee, Jae Seuk Park, Won Jung Koh, Dae Yun Kim, Tae Sun Shim

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Abstract

Background: Few studies have investigated the impact of diabetes mellitus (DM), a globally increasing metabolic disease, on treatment outcomes and long-term survival in patients with multidrug-resistant forms of tuberculosis (MDR-TB). Objectives: We analyzed outcomes in a large cohort to assess the impact of DM on treatment outcomes of patients with MDR-TB. Methods: MDR-TB patients newly diagnosed or retreated between 2000 and 2002 and followed for 8-11 years were retrospectively analyzed with respect to the effect of DM as a comorbidity on their treatment outcome and long-term survival. Results: Of 1,407 patients with MDR-TB, 239 (17.0%) had coexisting DM. The mean age and body mass index were higher in MDR-TB patients with DM [MDR-TBDM(+)] than in those without DM [MDR-TBDM(-)]. Patients with MDR-TB and a comorbidity of DM had a significantly lower treatment success rate than those without a history of DM (36.0 vs. 47.2%, p = 0.002). In addition, DM was the negative predictor for MDR-TB treatment success in multivariate analyses [odds ratio 0.51, 95% confidence interval (CI) 0.26-0.99]. Mean survival times were also lower in MDR-TBDM(+) than in MDR-TBDM(-) patients (102 vs. 114 months, p = 0.001), with DM as a significant predictor of poor long-term survival in multivariate analyses (hazard ratio 1.59, 95% CI 1.01-2.50). Conclusions: Among MDR-TB patients, DM was a relatively common comorbidity. In patients undergoing treatment for MDR-TB and followed for 8-11 years, it was found to be independently associated with an increased risk of both treatment failure and death.

Original languageEnglish
Pages (from-to)472-478
Number of pages7
JournalRespiration
Volume86
Issue number6
DOIs
Publication statusPublished - 2014 Jan

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine

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    Kang, Y. A., Kim, S. Y., Jo, K. W., Kim, H. J., Park, S. K., Kim, T. H., Kim, E. K., Lee, K. M., Lee, S. S., Park, J. S., Koh, W. J., Kim, D. Y., & Shim, T. S. (2014). Impact of diabetes on treatment outcomes and long-term survival in multidrug-resistant tuberculosis. Respiration, 86(6), 472-478. https://doi.org/10.1159/000348374