DIABETES PREVALENCE IN TB PATIENTS, TB SUSPECTS AND HEALTHY CONTROLS

Transcription

1 DIABETES PREVALENCE IN TB PATIENTS, TB SUSPECTS AND HEALTHY CONTROLS Thorny Linda Haraldsdottir Medical Student - Research year student Supervisors: Christian Wejse, MD, PhD Kirstine Stocholm Krag, MD, PhD Frauke Rudolf, MD, PhD student

2 TODAY S PRESENTATION Background TB and Diabetes Study Design the 3 cohorts Methods Screening and Diabetes Clinic Preliminary results Discussion Future

3 TUBERCULOSIS WORLDWIDE 1/3 of the world s population is presumed latently infected 9.4 million new TB cases in million people died from TB in cases per globally in cases per in Guinea-Bissau

4 DIABETES WORLDWIDE 285 million people worldwide have diabetes will reach 438 million by 2030 In 2004, 3.4 million people died from consequences of diabetes. Diabetes deaths will double between 2005 and % of people with diabetes live in low and middle income countries. Diabetes prevalence in Guinea Bissau is unknown.

5 THE ASSOCIATION BETWEEN TB AND DM DM appears to be an important risk factor for tuberculosis DM accelerates the progress of smear negative TB to the smear-positive form. DM pt with TB have greater bacterial concentration in the sputum DM may alter pharmacokinetics of TB treatment

6 A prospective cohort Study population - TB patients - TB suspects - Healthy controls

7 TB PATIENTS Adult patients (>15 years) living in the study area diagnosed with pulmonary TB. TB patients were screened for Diabetes at the inclusion and after their 6 months anti-tb treatment.

8 TB SUSPECTS people with symptoms or signs suggestive of TB : - cough - sputum production - weight loss Predinam inclusion at Belem Health Center and who have no verified TB diagnosis at the time of blood glucose measurement. Everyone >15 years who presented with one of the 3 symptoms of TB at consultation at Bandim, Belem or Cuntum Health Centers were offered to participate PREDINAM

9 HEALTHY CONTROLS The goal was to include 600 healthy persons living in the study area 198 houses were randomly chosen Every persons > 15 years, registered with PSB ID, were invited to participate - Questioners - Clinical examination - Blood glucose measurement Inclusion of controlperson in Bandim

10 SCREENING Random blood glucose was measured using Glucoflex-R strips Measures glucose levels of 1, 2, 4, 7, 9, 11, 17, 28, 44 mmol/l Glucoflex-R strips Everyone with a measure 7 mmol/l were referred to the Diabetes Clinic

11 THE DIABETES CLINIC 2 fasting measures of capillar blood with an Accu-Check glucose meter Control of blood pressure, information about diet, treatment Blood samples sent to Denmark (Hba1c) OGTT planned for everyone with IFG ( mmol/l) Clinica de Diabete, las Palmeras

12 FLOW CHART TB PATIENTS

13 FLOW CHART TB SUSPECTS

14 FLOW CHART HEALTHY CONTROLS 727 Healthy controls included 13 Previous TB treatment 55 Possibly TB suspects 651 Screened for DM 192 DM suspects 137 With a fasting blood glucose measure 8 Missing information 459 Glucoflex< 7 mmol/l 55 Loss to follow up 114 Not DM 8 IFG 14 DM

15 RESULTS - THE 3 COHORTS TB patients (n=126) TB suspects (n=389) Healthy controls (n=651) Female sex 50 (39.7%) 222 (57.1%) 408 (62.7%) Mean age (years) Mean BMI (kg/m 2) Mean MUAC (mm)

16 RESULTS - SCREENING Screened for DM TB patients n=126 TB suspects n=389 Healthy Controls n=651 Glucose <7 mmol/l 96 (76%) 329 (85%) 459 (71%) Glucose 7 mmol/l (DM suspects) 30 (24%) 60 (15%) 192 (29 %)

17 TB patients (n=22) TB suspects (n=45) Healthy Controls (n=137) DM 3 (14%) 8 (18%) 14 (11%) IFG 2 (9%) 4 (9%) 8 (6%) Not DM 17 (77%) 33 (73%) 114 (83%) The prevalence is calculated from DM suspects who have a fasting glucose measurement

18 DIABETES PREVALENCE TB patients (n=126) TB suspects (n=389) Healthy Controls (n=651) DM 3 (2.4%) 8 (2.1%) 14 (2.2%) IFG 2 (1.6%) 4 (1.0%) 8 (1.3%) The prevalence is calculated from everyone screened for DM Adjusted for age and sex no association between diabetes and TB was observed, OR =1.20 (95% CI: )

19 DISCUSSION Screening of DM is difficult as well as diagnosis Bias: Loss to follow up Not everyone with 2 fasting measures The randomization was not very good Is Glucoflex a good screening method?

20 THE FUTURE All TB patients included in the PSB TB cohort as well as TB suspects in Predinam will be screened for DM WDF has funded a 3 year project for DM awareness and case-finding Further DM studies at PSB? better treatment possibilites for Diabetes patients before further studies

21 ACKNOWLEDGEMENTS Aarhus University hospital - Dep. of Infectious Diseases Christian Wejse, MD, PhD (supervisor) Frauke Rudolf, MD, PhD stud. Lars Østergaard, MD, PhD, DMSc, Prof - Dep.of Internal Medicine and Endocrinology Kirstine Stochholm Krag, MD,PhD Odense University Hospital - Department of Endocrinology Henning Beck-Nielsen, MD, PhD, Prof - Department of Infectious Diseases Morten Bjerregaard-Andersen, MD, PhD stud. Bandim Health Project Peter Aaby, Prof, Dr.med Luis Carlos Joaquim, MD Victor Gomes, MD, PhD Grethe Lemvik, MD, PhD stud. Assistants of Equipa de TB Assistants of Clínica de Diabete The Predinam collaborators at the Health Centers of Belem, Bandim and Cuntum Staff at the TB- and HIV-laboratories at LNSP

22 Questions or comments?