Effect of Glycemic Control on Sputum Conversion at the End of Intensive Phase of Category I DOTS Therapy among Patients with Pulmonary Tuberculosis

Abstract

India is an endemic country of tuberculosis and diabetic capital of the world. A patient with diabetes has more chance of occurrence tuberculosis. Many studies pointed out the merging epidemic of diabetes and tuberculosis. Rifampicin and Isoniazid are the most prominent drugs in anti-TB treatment. These drugs disrupt the metabolism of many anti-hypoglycemic agents and lower the plasma levels, leading to hypogycemia. In non-diabetics, it impairs the release and action of insulin results in increased glucose levels in blood and thus increasing the probability of occurrence of diabetes. Present study attempts to compare the mean HbA1c level among the patients with category I pulmonary tuberculosis at the end of intensive phase of DOTS therapy with or without sputum conversion. The design adopted was cross sectional study and the setting was designated microscopy centres in Thiruvananthapuram district. The population included all newly diagnosed pulmonary TB patients of more than 18 years of age; receiving category I DOTS therapy in Thiruvananthapuram. The study got the ethical committee approval from the Institutional Ethics Committee. The data was collected from 120 participants. All the newly enrolled DOTS recipients (category I) were assessed for their glycemic status using Glucosylated haemoglobin (HbA1c) at the end of intensive phase and sputum examination were done on routine basis at the designated microscopic center. Glycosylated Haemoglobin (HbA1c) was taken as the proxy measure to estimate the glycemic control in diabetes patients. Individuals with HbA1C<7% were categorized as having good control and those with HbA1c>7%, as poor glycemic control. The result showed there is significant difference in mean HbA1c levels across groups (6.5 versus 8.8) with and without sputum conversion at the end of intensive phase of DOTS therapy. The study concludes that the adequate glycemic control is the major determinant in the conversion of sputum in patients with diabetes. The study also reveals that that those with poor glycemic control have 5.96 times more chance of sputum remaining positive at the end of intensive phase of DOTS therapy than the patients with good glycemic control.