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Int J Tuberc Lung Dis. 2018 Jun 1;22(6):686-694. doi: 10.5588/ijtld.17.0598.

Diabetes and pre-diabetes among household contacts of tuberculosis patients in India: is it time to screen them all?

Author information

1
Johns Hopkins University-India Office, Pune, Maharashtra.
2
National Institute for Research in Tuberculosis, Chennai, Tamil Nadu, India.
3
International Union Against Tuberculosis and Lung Disease, Paris, France.
4
Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India.
5
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
6
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
7
Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India, Byramjee Jeejeebhoy Government Medical College, Pune, India.
8
Pondicherry Institute of Medical Sciences (PIMS), Puducherry.
9
Byramjee Jeejeebhoy Government Medical College, Johns Hopkins University Clinical Research site, Pune, Maharashtra, India, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.
10
Indian Council of Medical Research, New Delhi, India.

Abstract

SETTING:

Pre-diabetes mellitus (pre-DM) and DM increase the risk of developing tuberculosis (TB). Screening contacts of TB patients for pre-DM/DM and linking them to care may mitigate the risk of developing TB and improve DM management.

OBJECTIVE:

To measure the prevalence of pre-DM/DM and associated factors among the adult household contacts (HHCs) of pulmonary TB patients.

METHODS:

Between August 2014 and May 2017, adult HHCs of newly diagnosed adult PTB patients in Pune and Chennai, India, had single blood samples tested for glycosylated haemoglobin (HbA1c) at enrolment. DM was defined as previously diagnosed, self-reported DM or HbA1c 6.5%, and pre-DM as HbA1c between 5.7% and 6.4%. Latent tuberculous infection (LTBI) was defined as a positive tuberculin skin test (5 mm induration) or QuantiFERON® Gold In-Tube (0.35 international units/ml).

RESULTS:

Of 652 adult HHCs, 175 (27%) had pre-DM and 64 (10%) had DM. Forty (64%) HHCs were newly diagnosed with DM and 48 (75%) had poor glycaemic control (HbA1c 7.0%). Sixty-eight (22%) pre-DM cases were aged 18-34 years. Age 35 years, body mass index 25 kg/m2, chronic disease and current tobacco smoking were significantly associated with DM among HHCs.

CONCLUSIONS:

Adult HHCs of TB patients in India have a high prevalence of undiagnosed DM, pre-DM and LTBI, putting them at high risk for developing TB. Routine DM screening should be considered among all adult HHCs of TB.

PMID:
29862955
DOI:
10.5588/ijtld.17.0598

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