@article{04f650e1384245038570e81182174f7f,
title = "Trends in HbA1c levels and implications for diabetes screening in tuberculosis cases undergoing treatment in India",
abstract = "SETTING: The optimal timing of screening for diabetes mellitus (DM) among tuberculosis (TB) cases is unclear due to the possibility of stress hyperglycemia. DESIGN: We evaluated adult (≥18 years) pulmonary TB cases at treatment initiation as well as at 3 months, 6 months and 12 months. DM was identified by self-report (known DM) or glycated hemoglobin (HbA1c) ≥ 6.5% (new DM). Trends in HbA1c levels during treatment were assessed using non-parametric tests. RESULT S : Of the 392 participants enrolled, 75 (19%) had DM, 30 (40%) of whom had new DM. Of the 45 participants with known DM, respectively 37 (82%) and 40 (89%) received medication to lower glucose levels at treatment initiation and completion; one participant with new DM initiated glucose-lowering medication during follow-up. The median HbA1c level in participants with known, new and no DM was respectively 10.1% (interquartile range [IQR] 8.3-11.6), 8.5% (IQR 6.7-11.5) and 5.6% (IQR 5.3-5.9) at treatment initiation, and 8.7% (IQR 6.8-11.3), 7.1% (IQR 5.8- 9.5) and 5.3% (IQR 5.1-5.6) at treatment completion (P < 0.001). Overall, 5 (12%) with known and 13 (43%) with new DM at treatment initiation had reverted to HbA1c < 6.5% by treatment completion (P = 0.003); the majority of reversions occurred during the first 3 months, with no significant reversions beyond 6 months. CONCLUSION: HbA1c levels declined with anti-tuberculosis treatment. Repeat HbA1c testing at treatment completion could reduce the risk of misdiagnosis of DM.",
keywords = "DM, Glycated hemoglobin, India, TB, Transient hyperglycemia",
author = "Gupte, {A. N.} and V. Mave and S. Meshram and R. Lokhande and D. Kadam and S. Dharmshale and R. Bharadwaj and A. Kagal and N. Pradhan and S. Deshmukh and S. Atre and T. Sahasrabudhe and M. Barthwal and S. Meshram and A. Kakrani and V. Kulkarni and S. Raskar and N. Suryavanshi and R. Shivakoti and S. Chon and E. Selvin and N. Gupte and A. Gupta and Golub, {J. E.}",
note = "Funding Information: Funding: This work was supported primarily by the United States National Institutes of Health (NIH), Bethesda, MD, USA (R01AI097494 to JG). Additional support for this work was obtained through Federal funds from the Government of India{\textquoteright}s (GOI{\textquoteright}s) Department of Biotechnology (DBT; New Delhi), the Indian Council of Medical Research (ICMR; New Delhi, India), the United States NIH, National Institute of Allergy and Infectious Diseases (NIAID), Office of AIDS Research (OAR), and distributed in part by CRDF Global (Arlington, VA, USA) (USB1-31147-XX-13 CRDF/NIH to AG), and the NIH-funded Johns Hopkins Baltimore-Washington-India Clinical Trials Unit for NIAID Networks (U01AI069497 to VM, NG, AG). ES was supported by NIH/ National Institute of Diabetes and Digestive and Kidney Diseases grants K24DK106414 and R01DK089174. RS was supported by NIH/National Institute of Child Health and Human Development grant K99HD089753. RL was supported by the BJGMC JHU HIV TB Program funded by the Fogarty International Center, Bethesda, MD, USA (NIH grant D43TW009574). ANG was supported by NIH Research Training Grant # D43 TW009340 funded by the NIH Fogarty International Center, the National Institute of Neurological Disorders and Stroke, the National Institute of Mental Health, the National Heart, Lung, and Blood Institute and the National Institute of Environmental Health Sciences (Bethesda, MD, USA). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the funders. Conflicts of interest: none declared. Funding Information: The authors thank the study participants for their time and contributions. Funding: This work was supported primarily by the United States National Institutes of Health (NIH), Bethesda, MD, USA (R01AI097494 to JG). Additional support for this work was obtained through Federal funds from the Government of India's (GOI's) Department of Biotechnology (DBT; New Delhi), the Indian Council of Medical Research (ICMR; New Delhi, India), the United States NIH, National Institute of Allergy and Infectious Diseases (NIAID), Office of AIDS Research (OAR), and distributed in part by CRDF Global (Arlington, VA, USA) (USB1-31147-XX- 13 CRDF/NIH to AG), and the NIH-funded Johns Hopkins Baltimore-Washington-India Clinical Trials Unit for NIAID Networks (U01AI069497 to VM, NG, AG). ES was supported by NIH/ National Institute of Diabetes and Digestive and Kidney Diseases grants K24DK106414 and R01DK089174. RS was supported by NIH/National Institute of Child Health and Human Development grant K99HD089753. RL was supported by the BJGMC JHU HIV TB Program funded by the Fogarty International Center, Bethesda, MD, USA (NIH grant D43TW009574). ANG was supported by NIH Research Training Grant # D43 TW009340 funded by the NIH Fogarty International Center, the National Institute of Neurological Disorders and Stroke, the National Institute of Mental Health, the National Heart, Lung, and Blood Institute and the National Institute of Environmental Health Sciences (Bethesda, MD, USA). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the funders. Publisher Copyright: {\textcopyright} 2018 The Union.",
year = "2018",
month = jul,
day = "1",
language = "English (US)",
volume = "22",
pages = "800--806",
journal = "International Journal of Tuberculosis and Lung Disease",
issn = "1027-3719",
publisher = "International Union against Tubercul. and Lung Dis.",
number = "7",
}