Clinical-demographic markers for improving diabetes mellitus diagnosis in people with tuberculosis in Tanzania.

BACKGROUND: Tuberculosis (TB) control is threatened by an increasing prevalence of diabetes mellitus (DM), particularly in endemic countries. Screening for DM is not routinely implemented in Tanzania; therefore, we aimed to screen for DM at TB diagnosis using clinical-demographic markers. METHODS: Our cross-sectional study recruited TB patients who received anti-TB treatment between October 2019 and September 2020 at health care facilities in three regions from Tanzania. Patients were screened for DM using DM symptoms (polydipsia, polyphagia and polyuria) and random blood glucose (RBG) testing. Patients with a history of DM and those with no history of DM but an RBG ≥ 7.8 mmol/L had point-of-care glycated haemoglobin (HbA1c) testing, and were considered to have DM if HbA1c was ≥ 48 mmol/mol. RESULTS: Of 1344 TB patients, the mean age was 41.0 (± 17.0) years, and 64.7% were male. A total of 1011 (75.2%) had pulmonary TB, and 133 (10.4%) had at least one DM symptom. Overall, the prevalence of DM was 7.8%, of which 36 (2.8%) TB patients with no history of DM were newly diagnosed with DM by RBG testing. TB/DM patients were older than those with only TB (50.0 ± 14.0 years vs 40.0 ± 17.0 years, p < 0.001). Patients with RBG ≥ 7.8 mmol/L were more likely to have pulmonary TB (p = 0.003), age ≥ 35 years (p = 0.018), and have at least one DM symptom (p < 0.001). There was a substantial agreement (Kappa = 0.74) between the on-site glucometer and point-of-care HbA1c tests in detecting DM range of hyperglycemia. CONCLUSION: The implementation of clinical-demographic markers and blood glucose screening identified the overall prevalence of DM and those at risk of DM in TB patients. Clinical-demographic markers are independent predictors for DM range hyperglycemia and highlight the importance of further diagnostic testing and early co-management of TB and DM.

Assessing the Effectiveness of Type 2 Diabetes Screening in the Republic of Uzbekistan.

Background: Type 2 diabetes (T2D) screening should be performed continuously at the primary care level in order to prevent disabling complications. Due to the high prevalence of undiagnosed T2D in the Republic of Uzbekistan, a decision was made to implement a nationwide screening program for T2D. Objectives: The current study, taking into account the limited resources of Uzbekistan's health care system, aimed to offer the most effective, simple, and economical option required for the actual implementation of regular T2D screening in the country's primary care. Methods: The screening was conducted from December 2018 to March 2019. There were four different scenarios, which differed in terms of eligibility criteria and the methodology adopted for detecting dysglycemia. Results: A total of 2,430 patients were examined in four months. The T2D diagnosis was established by an endocrinologist in 9.3% of the cases with one eligibility criterion and 15.9% of the cases with three eligibility criteria. The diagnosis of T2D was established by an endocrinologist in 11.7% of the cases with HbA1c screening and 13.5% of the cases with glucose screening. Conclusions: The screening was feasible in Uzbekistan only in limited conditions. The reasonable strategy was found to be the screening for incidental glycemia in all patients with at least one T2D risk factor. It was recommended that patients with incidental glycemia ≥ 7.8 mmol/L should be tested for fasting glycemia.

Screening adult tuberculosis patients for diabetes mellitus in Ebeye, Republic of the Marshall Islands.

A retrospective cohort study was conducted to evaluate the screening of adult TB patients for diabetes (DM) using glycated haemoglobin (HbA1C) in Ebeye, Republic of the Marshall Islands. Of 62 patients registered between July 2010 and December 2012, 28 (45%) had DM. The only significant difference in baseline characteristics between those with and those without DM was higher age in those with DM. Two-month sputum smears and cultures were also not different between the two groups. Despite the limited sample size, this study shows that screening TB patients for DM in Ebeye is feasible and worthwhile and that it should be continued.

Une étude rétrospective de cohorte a été réalisée afin d'évaluer le dépistage du diabète (DM) chez des patients tuberculeux adultes grâce à l'hémoglobine glycosylée (HbAIC) à Ebeye, République des îles Marshall. Entre juillet 2010 et décembre 2012, 62 patients ont été enregistrés, parmi lesquels 28 (45%) avaient un DM. La seule différence significative dans les caractéristiques de départ entre les patients était un âge plus avancé pour les diabétiques. Les frottis et cultures de crachats à 2 mois étaient similaires. Malgré la taille limitée de l'échantillon, cette étude montre que le dépistage du DM chez les patients tuberculeux est faisable et utile et devrait être poursuivi.

Se llevó a cabo un estudio retrospectivo de cohortes con el fin de examinar la detección sistemática de la diabetes mellitus (DM) en los pacientes adultos con diagnóstico de tuberculosis (TB), mediante la determinación de la hemoglobina glucosilada (HbA1C) en Ebeye, en la República de las Islas Marshall. Se registraron 62 pacientes entre julio del 2010 y diciembre del 2012, de los cuales 28 eran diabéticos (45%). La única diferencia significativa en las características iniciales de los pacientes con y sin DM fue una edad mayor de los pacientes con DM. No se observó diferencia entre los grupos de los resultados de la baciloscopia ni el cultivo del esputo a los 2 meses. Pese al tamaño reducido de la muestra, el presente estudio pone en evidencia que la detección sistemática de la DM en los pacientes con diagnóstico de TB es factible, útil y que se debe continuar.

A Review on the Factors Influencing the Attendance of Postpartum Diabetes Screening for Mothers with Gestational Diabetes Mellitus

Abstract@#Women with gestational diabetes mellitus (GDM) during their pregnancy have a greater risk of developing overt diabetes mellitus and dysglycemia (prediabetes, impaired glucose tolerance or impaired fasting glucose) later in future, compared to mothers with normal pregnancy. Postpartum screening is crucial for early identification of type 2 diabetes (T2DM) in women with GDM. Nevertheless, despite various strategies, its rate remains low. A systematic review using databases of PubMed/Medline, Science Direct and CINAHL from 2008 to 2018, was conducted to identify the factors influencing the attendance of postpartum diabetes screening. Open access English articles, focusing on observational studies were reviewed. Primary screening of titles and abstracts of 91 articles were done, secondary screening of 31 articles resulted in 6 articles, included in this manuscript. Various factors identified to be associated with the attendance to postpartum diabetes screening, which are age, education, ethnicity, some obstetric factors like multiparty, and history of insulin usage previously. Many women fail to be screened for diabetes during the postpartum period, and this delays T2DM diagnosis, which in turn gives rise to various complications. Further research that considers these factors is necessary for developing interventions to improve postpartum T2DM screening for mothers with GDM during their pregnancy