Impact of Diabetes on Treatment Outcomes and Long-Term Survival in Multidrug-Resistant Tuberculosis

• Published in: Respiration Vol. 86; no. 6; pp. 472 - 478
• Main Authors: Kang, Young Ae, Kim, Song Yee, Jo, Kyung-Wook, Kim, Hee Jin, Park, Seung-Kyu, Kim, Tae-Hyung, Kim, Eun Kyung, Lee, Ki Man, Lee, Sung Soon, Park, Jae Seuk, Koh, Won-Jung, Kim, Dae Yun, Shim, Tae Sun
• Format: Journal Article
• Language: English
• Published: Basel, Switzerland S. Karger AG 01.01.2013
• Subjects: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Body Mass Index; Clinical Investigations; Clinical outcomes; Cohort Studies; Comorbidity; Diabetes; Diabetes Mellitus - epidemiology; Drug resistance; Female; Follow-Up Studies; Humans; Kaplan-Meier Estimate; Male; Medical treatment; Middle Aged; Multivariate Analysis; Mycobacterium; Republic of Korea - epidemiology; Retrospective Studies; Treatment Failure; Tuberculosis; Tuberculosis, Multidrug-Resistant - drug therapy; Tuberculosis, Multidrug-Resistant - epidemiology; Young Adult; Republic of Korea; Multidrug-resistant tuberculosis; Treatment; Survival; Diabetes mellitus; Outcome
• ISSN: 0025-7931; 1423-0356
• DOI: 10.1159/000348374

Background: Few studies have investigated the impact of diabetes mellitus (DM), a globally increasing metabolic disease, on treatment outcomes and long-term survival in patients with multidrug-resistant forms of tuberculosis (MDR-TB). Objectives: We analyzed outcomes in a large cohort to assess the impact of DM on treatment outcomes of patients with MDR-TB. Methods: MDR-TB patients newly diagnosed or retreated between 2000 and 2002 and followed for 8-11 years were retrospectively analyzed with respect to the effect of DM as a comorbidity on their treatment outcome and long-term survival. Results: Of 1,407 patients with MDR-TB, 239 (17.0%) had coexisting DM. The mean age and body mass index were higher in MDR-TB patients with DM [MDR-TB DM(+) ] than in those without DM [MDR-TB DM(-) ]. Patients with MDR-TB and a comorbidity of DM had a significantly lower treatment success rate than those without a history of DM (36.0 vs. 47.2%, p = 0.002). In addition, DM was the negative predictor for MDR-TB treatment success in multivariate analyses [odds ratio 0.51, 95% confidence interval (CI) 0.26-0.99]. Mean survival times were also lower in MDR-TB DM(+) than in MDR-TB DM(-) patients (102 vs. 114 months, p = 0.001), with DM as a significant predictor of poor long-term survival in multivariate analyses (hazard ratio 1.59, 95% CI 1.01-2.50). Conclusions: Among MDR-TB patients, DM was a relatively common comorbidity. In patients undergoing treatment for MDR-TB and followed for 8-11 years, it was found to be independently associated with an increased risk of both treatment failure and death.