Diabetes mellitus among pulmonary tuberculosis patients from four TB-endemic countries: the TANDEM study

Diabetes mellitus (DM) increases the risk of active tuberculosis (TB) and worsens TB outcomes, putting TB control in jeopardy especially in TB endemic countries with rising DM prevalence rates. We assessed DM status and clinical correlates in TB patients across settings in Indonesia, Peru, Romania and South Africa. Age-adjusted DM prevalence was estimated using laboratory glycated haemoglobin (HbA1c) or fasting plasma glucose (FPG) in TB patients. Detailed and standardized socio-demographic, anthropometric and clinical measurements were made. Characteristics of TB patients with or without DM were compared using multi-level mixed effect regression models with robust standard errors. Of 2185 TB patients (median 36.6 years, 61.2% male, 3.8% HIV-infected), 12.5% (267/2128) had DM, 1/3 of whom were newly diagnosed. Age-standardized DM prevalence ranged from 10.9% (South Africa) to 19.7% (Indonesia). Median HbA1c in TB-DM patients ranged from 7.4% (Romania) to 11.3% (Indonesia). Compared to those without DM, TB-DM patients were older with higher Body Mass Index (BMI) (p-value We show that DM prevalence and clinical characteristics of TB-DM vary considerably between countries. Diabetes is mostly known but untreated, hyperglycemia is often severe, and many patients with combined TB and DM have significant cardiovascular disease risk and severe TB, underlining the need to improve strategies for better clinical management of combined TB and DM.