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Impact of Diabetes Mellitus on Treatment Outcomes of Patients with Active Tuberculosis

Diabetes mellitus (DM) is an emerging chronic health condition of developed and developing countries. We conducted a retrospective cohort study of patients with active, culture-confirmed tuberculosis (TB) in Maryland to determine the impact of DM on TB treatment outcomes. Of 297 TB patients, 42 (14%) had DM. Patients with diabetes had 2.0 times higher odds of death than patients without diabetes (95% confidence interval [CI] 0.74–5.2, P = 0.18). Adjusting for human immunodeficiency virus (HIV), age, weight, and foreign birth, the odds of death were 6.5 times higher in patients with diabetes than patients without diabetes (95% CI 1.1–38.0, P = 0.039). In pulmonary TB patients, time to sputum culture conversion was longer in patients with diabetes than patients without diabetes (median 49 versus 39 days, P = 0.09). Two-month culture conversion proportions were similar (70% and 69%). Treatment failure occurred in 4.1% of patients without diabetes and 6.7% of patients with diabetes (P = 0.51). In conclusion, DM was a risk factor for death in Maryland TB patients. There was a trend toward increased time to culture conversion; two-month culture conversion proportions, however, were similar.

Received November 6, 2008. Accepted for publication January 9, 2009.

Acknowledgments: We thank Thomas Walsh, Karla Alwood, and Akintoye Adelakun, who provided clinical care; Lynn Federline, Sherry Johnson, and Yvonne Richards who facilitated medical record reviews; and Dipti Shah, coordinator of the Public Health Applications for Student Experience (PHASE) program at the Maryland Department of Health and Mental Hygiene.

Financial support: This study was supported by grants from the National Institutes of Health including 5 T32 GM066691 to K.D., K23AI51528 to S.D., and K01AI066994 to J.G.

^* Address correspondence to Kelly E. Dooley, Divisions of Clinical Pharmacology and Infectious Diseases, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Osler 527, Baltimore, MD 21287. E-mail: kdooley1{at}jhmi.edu

Authors’ addresses: Kelly E. Dooley, Divisions of Clinical Pharmacology and Infectious Diseases, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Osler 527, Baltimore, MD 21287, Tel: 410-955-3100, Fax: 410-614-9978, E-mail: kdooley1{at}jhmi.edu. Tania Tang, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Box 119, Baltimore, MD 21205, Tel: 510-381-3623, Fax: c/o Jonathan Golub 410-955-0740, E-mail: ttang{at}jhsph.edu. Jonathan Golub, Infectious Diseases, Johns Hopkins University School of Medicine, and Johns Hopkins University School of Public Health, Center for Tuberculosis Research, CRB II 1M.07, 1550 Orleans Street, Baltimore, MD 21231, Tel: 443-287-2969, Fax: 410-955-0740, E-mail: jgolub{at}jhmi.edu. Susan E. Dorman, Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Center for Tuberculosis Research, CRBII 1M.08, Tel: 410-955-1755, Fax: 410-955-0740, E-mail: dsu-san1{at}jhmi.edu. Wendy Cronin, Division of TB Control, Refugee and Migrant Health, Maryland Department of Health and Mental Hygiene, 201 W. Preston Street, Room 307-A, Baltimore, MD 21201, Tel: 410-767-6693, Fax: 410-669-4215, E-mail: croninw{at}dhmh.state.md.us.