Tuberculosis screening among persons with diabetes mellitus in Pune, India

Vidya Mave, Smita Nimkar, Haridas Prasad, Dileep Kadam, Sushant Meshram, Rahul Lokhande, Nikhil Gupte, Divyashri Jain, Amita Gupta, Jonathan E Golub

Research output: Contribution to journalArticle

Abstract

Background: Diabetes mellitus (DM) increases tuberculosis (TB) risk, and there is increasing concern over the public health implications of the convergence of these two epidemics. Screening for TB among people with DM is now recommended in India. Methods: People with DM seeking care at a large public sector tertiary care hospital clinic in Pune, India, were screened for TB from June 2015 to May 2016. All consenting people with DM were screened for TB at each clinic visit using a five-item, WHO-recommended questionnaire and those with TB symptoms and/or risk factors were tested for active TB using sputum smear microscopty, Xpert® MTB/RIF and TB culture. Categorical data and continuous variables were summarized using descriptive statistics. The x 2 test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively. Results: Among 630 adults approached for screening, median age was 60 (interquartile range (IQR), 57-64) years and 350 (56%) were females. Median hemoglobin A1c (HbA1c) was 8.7% (IQR, 6.7-9.9) and 444 (70.5%) were poorly controlled DM (HbA1c > 7). Forty-four (7%) had prior history of TB but the proportion with TB risk factors at screening was low (<5%). While 18% of participants reported any TB symptoms, none of these patients were diagnosed with culture confirmed TB. Conclusions: Our study failed to yield any active TB cases using a WHO-recommended questionnaire among people with DM. High TB risk populations among people with DM must be identified if TB screening is to be feasible in settings such as India where the DM epidemic continues to rise.

Original languageEnglish (US)
Article number388
JournalBMC Infectious Diseases
Volume17
Issue number1
DOIs
StatePublished - Jun 2 2017

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India
Diabetes Mellitus
Tuberculosis
Nonparametric Statistics
Hemoglobins
Public Sector
Tertiary Healthcare
Ambulatory Care
Sputum
Tertiary Care Centers
Public Health

Keywords

  • Diabetes mellitus
  • India
  • Risk factors
  • Screening
  • Tuberculosis

ASJC Scopus subject areas

  • Infectious Diseases

Cite this

Tuberculosis screening among persons with diabetes mellitus in Pune, India. / Mave, Vidya; Nimkar, Smita; Prasad, Haridas; Kadam, Dileep; Meshram, Sushant; Lokhande, Rahul; Gupte, Nikhil; Jain, Divyashri; Gupta, Amita; Golub, Jonathan E.

In: BMC Infectious Diseases, Vol. 17, No. 1, 388, 02.06.2017.

Research output: Contribution to journalArticle

Mave, Vidya ; Nimkar, Smita ; Prasad, Haridas ; Kadam, Dileep ; Meshram, Sushant ; Lokhande, Rahul ; Gupte, Nikhil ; Jain, Divyashri ; Gupta, Amita ; Golub, Jonathan E. / Tuberculosis screening among persons with diabetes mellitus in Pune, India. In: BMC Infectious Diseases. 2017 ; Vol. 17, No. 1.
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abstract = "Background: Diabetes mellitus (DM) increases tuberculosis (TB) risk, and there is increasing concern over the public health implications of the convergence of these two epidemics. Screening for TB among people with DM is now recommended in India. Methods: People with DM seeking care at a large public sector tertiary care hospital clinic in Pune, India, were screened for TB from June 2015 to May 2016. All consenting people with DM were screened for TB at each clinic visit using a five-item, WHO-recommended questionnaire and those with TB symptoms and/or risk factors were tested for active TB using sputum smear microscopty, Xpert{\circledR} MTB/RIF and TB culture. Categorical data and continuous variables were summarized using descriptive statistics. The x 2 test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively. Results: Among 630 adults approached for screening, median age was 60 (interquartile range (IQR), 57-64) years and 350 (56{\%}) were females. Median hemoglobin A1c (HbA1c) was 8.7{\%} (IQR, 6.7-9.9) and 444 (70.5{\%}) were poorly controlled DM (HbA1c > 7). Forty-four (7{\%}) had prior history of TB but the proportion with TB risk factors at screening was low (<5{\%}). While 18{\%} of participants reported any TB symptoms, none of these patients were diagnosed with culture confirmed TB. Conclusions: Our study failed to yield any active TB cases using a WHO-recommended questionnaire among people with DM. High TB risk populations among people with DM must be identified if TB screening is to be feasible in settings such as India where the DM epidemic continues to rise.",
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T1 - Tuberculosis screening among persons with diabetes mellitus in Pune, India

AU - Mave, Vidya

AU - Nimkar, Smita

AU - Prasad, Haridas

AU - Kadam, Dileep

AU - Meshram, Sushant

AU - Lokhande, Rahul

AU - Gupte, Nikhil

AU - Jain, Divyashri

AU - Gupta, Amita

AU - Golub, Jonathan E

PY - 2017/6/2

Y1 - 2017/6/2

N2 - Background: Diabetes mellitus (DM) increases tuberculosis (TB) risk, and there is increasing concern over the public health implications of the convergence of these two epidemics. Screening for TB among people with DM is now recommended in India. Methods: People with DM seeking care at a large public sector tertiary care hospital clinic in Pune, India, were screened for TB from June 2015 to May 2016. All consenting people with DM were screened for TB at each clinic visit using a five-item, WHO-recommended questionnaire and those with TB symptoms and/or risk factors were tested for active TB using sputum smear microscopty, Xpert® MTB/RIF and TB culture. Categorical data and continuous variables were summarized using descriptive statistics. The x 2 test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively. Results: Among 630 adults approached for screening, median age was 60 (interquartile range (IQR), 57-64) years and 350 (56%) were females. Median hemoglobin A1c (HbA1c) was 8.7% (IQR, 6.7-9.9) and 444 (70.5%) were poorly controlled DM (HbA1c > 7). Forty-four (7%) had prior history of TB but the proportion with TB risk factors at screening was low (<5%). While 18% of participants reported any TB symptoms, none of these patients were diagnosed with culture confirmed TB. Conclusions: Our study failed to yield any active TB cases using a WHO-recommended questionnaire among people with DM. High TB risk populations among people with DM must be identified if TB screening is to be feasible in settings such as India where the DM epidemic continues to rise.

AB - Background: Diabetes mellitus (DM) increases tuberculosis (TB) risk, and there is increasing concern over the public health implications of the convergence of these two epidemics. Screening for TB among people with DM is now recommended in India. Methods: People with DM seeking care at a large public sector tertiary care hospital clinic in Pune, India, were screened for TB from June 2015 to May 2016. All consenting people with DM were screened for TB at each clinic visit using a five-item, WHO-recommended questionnaire and those with TB symptoms and/or risk factors were tested for active TB using sputum smear microscopty, Xpert® MTB/RIF and TB culture. Categorical data and continuous variables were summarized using descriptive statistics. The x 2 test or Wilcoxon rank-sum test was used to ascertain significant associations between categorical and continuous variables, respectively. Results: Among 630 adults approached for screening, median age was 60 (interquartile range (IQR), 57-64) years and 350 (56%) were females. Median hemoglobin A1c (HbA1c) was 8.7% (IQR, 6.7-9.9) and 444 (70.5%) were poorly controlled DM (HbA1c > 7). Forty-four (7%) had prior history of TB but the proportion with TB risk factors at screening was low (<5%). While 18% of participants reported any TB symptoms, none of these patients were diagnosed with culture confirmed TB. Conclusions: Our study failed to yield any active TB cases using a WHO-recommended questionnaire among people with DM. High TB risk populations among people with DM must be identified if TB screening is to be feasible in settings such as India where the DM epidemic continues to rise.

KW - Diabetes mellitus

KW - India

KW - Risk factors

KW - Screening

KW - Tuberculosis

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