Abstract

Background

It is unclear whether diabetes or prediabetes affects unfavorable treatment outcomes and death in people with tuberculosis (PWTB).

Methods

Culture-confirmed, drug-susceptible PWTB, enrolled in the Regional Prospective Observational Research in Tuberculosis (RePORT)–Brazil cohort between 2015 and 2019 (N = 643) were stratified based on glycemic status according to baseline glycated hemoglobin. Unfavorable tuberculosis (TB) outcome was defined as treatment failure or modification, recurrence, or death; favorable outcome was cure or treatment completion. We corroborated the findings using data from PWTB reported to the Brazilian National System of Diseases Notification (SINAN) during 2015–2019 (N = 20 989). Logistic regression models evaluated associations between glycemic status and outcomes.

Results

In both cohorts, in univariate analysis, unfavorable outcomes were more frequently associated with smoking, illicit drug use, and human immunodeficiency virus infection. Diabetes, but not prediabetes, was associated with unfavorable outcomes in the RePORT-Brazil (adjusted relative risk [aRR], 2.45; P < .001) and SINAN (aRR, 1.76; P < .001) cohorts. Furthermore, diabetes was associated with high risk of death (during TB treatment) in both RePORT-Brazil (aRR, 2.16; P = .040) and SINAN (aRR, 1.93; P = .001).

Conclusions

Diabetes was associated with an increased risk of unfavorable outcomes and mortality in Brazilian PWTB. Interventions to improve TB treatment outcomes in persons with diabetes are needed.

中文翻译：

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糖尿病和糖尿病前期对抗结核治疗结果的影响：多中心前瞻性队列研究

 抽象的

 背景

目前尚不清楚糖尿病或糖尿病前期是否会影响结核病患者 (PWTB) 的不良治疗结果和死亡。

 方法

2015 年至 2019 年期间参加结核病区域前瞻性观察研究 (RePORT) 的巴西队列 (N = 643) 的经培养确认的药物敏感 PWTB 根据基线糖化血红蛋白的血糖状态进行分层。结核病（TB）不良结果被定义为治疗失败或修改、复发或死亡；有利的结果是治愈或治疗完成。我们使用 2015 年至 2019 年期间向巴西国家疾病通报系统 (SINAN) 报告的 PWTB 数据证实了这些发现（N = 20 989）。逻辑回归模型评估血糖状态和结果之间的关联。

 结果

在这两个队列中，在单变量分析中，不良结果更频繁地与吸烟、非法药物使用和人类免疫缺陷病毒感染相关。在 RePORT-Brazil（调整后相对风险 [aRR]，2.45； P < .001）和 SINAN（aRR，1.76； P < .001）队列中，糖尿病（而非糖尿病前期）与不良结果相关。此外，在 RePORT-Brazil（aRR，2.16； P = .040）和 SINAN（aRR，1.93； P = .001）中，糖尿病与高死亡风险（结核病治疗期间）相关。

 结论

在巴西 PWTB 中，糖尿病与不良结果和死亡率风险增加相关。需要采取干预措施来改善糖尿病患者的结核病治疗结果。