Effect of glycemic control on tuberculosis treatment outcomes among patients with tuberculosis and diabetes mellitus: A systematic review and meta-analysis.
IF 2.6 4区 医学Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH
Maham Zahid, Saima Afaq, Kashif Shafique, Fatima Khalid Qazi, Urooj Khan, Muhammad Asim, Shaista Nooreen, Sofia Shehzad
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引用次数: 0
Abstract
Introduction: Tuberculosis (TB) and diabetes mellitus comorbidity can lead to poor TB treatment outcomes, particularly with uncontrolled blood glucose levels. Understanding the impact of glycemic control on TB treatment outcomes is essential.
Objective: To synthesise evidence on the association between glycemic control and TB treatment outcomes in patients with TB and diabetes mellitus.
Methodology: A systematic review was conducted using Medline, Embase, Scopus, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Google Scholar for all types of studies published between 1975 and May 2024, including adult TB patients of >18 years of age, with or without diabetes mellitus for whom blood glucose testing along with TB treatment outcome comparison with glucose levels (low/high) was reported were considered for inclusion. A random-effects model was used for meta-analysis, heterogeneity was assessed using I-squared statistics, subgroup and sensitivity analysis was performed followed by publication bias assessment.
Results: Of 576 identified studies, 12 met the inclusion criteria, analysing 2320 cases (1572 with uncontrolled high blood glucose [≥7% HbA1c] and 748 with controlled low blood glucose [<7% HbA1c]). Low certainty evidence shows that patients with uncontrolled high glucose had a 1.91 times higher risk of TB treatment failure (risk ratios [RR] = 1.91, 95% confidence interval [CI] 1.81-3.07, p = 0.008), and a 2.97 times higher risk of sputum positivity at 3 months (RR = 2.97, 95% CI 1.10-8.07, p = 0.03). Subgroup and sensitivity analyses showed significant improvement in pooled effects, lowering of heterogeneity and narrower CIs. For overall pooled effect, substantial heterogeneity was observed; therefore, the interpretation and generalisation of results should be done with caution.
Conclusion: A low certainty evidence shows that uncontrolled high blood glycemic level significantly impacts TB treatment outcomes, increasing treatment failure and sputum positivity among TB patients with diabetes mellitus.
结核病(TB)和糖尿病的合并症可导致结核病治疗结果不佳,特别是血糖水平不受控制。了解血糖控制对结核病治疗结果的影响至关重要。目的:探讨糖尿病合并结核病患者血糖控制与治疗效果的关系。方法:使用Medline、Embase、Scopus、Web of Science、护理和联合健康文献累积索引(CINAHL)和谷歌Scholar对1975年至2024年5月期间发表的所有类型的研究进行了系统回顾,包括>18岁的成年结核病患者,伴有或不伴有糖尿病,他们的血糖检测以及结核病治疗结果与血糖水平(低/高)的比较被纳入考虑。meta分析采用随机效应模型,异质性评价采用i方统计,亚组分析和敏感性分析后进行发表偏倚评价。结果:在纳入的576项研究中,有12项研究符合纳入标准,共分析了2320例病例(1572例为未控制的高血糖[≥7% HbA1c], 748例为控制的低血糖[结论:低确定性证据表明,未控制的高血糖水平显著影响结核病治疗结果,增加结核病合并糖尿病患者的治疗失败和痰阳性。
期刊介绍:
Tropical Medicine & International Health is published on behalf of the London School of Hygiene and Tropical Medicine, Swiss Tropical and Public Health Institute, Foundation Tropical Medicine and International Health, Belgian Institute of Tropical Medicine and Bernhard-Nocht-Institute for Tropical Medicine. Tropical Medicine & International Health is the official journal of the Federation of European Societies for Tropical Medicine and International Health (FESTMIH).