Sains Malaysiana 49(5)(2020): 1081-1088

http://dx.doi.org/10.17576/jsm-2020-4905-12

 

Tuberculosis and Associated Factors among Type 2 Diabetic Patients in Perak: A Case Control Study

 

(Tuberkulosis dan Faktor Berkaitan dalam Kalangan Pesakit Diabetis Jenis 2 di Perak: Suatu Kajian Kes Kawalan)

 

KUI CHOON YONG¹, NOOR AZIMAH MUHAMMAD²*, WEI-YIN LIM³ & AMAR-SINGH HSS³

 

¹Klinik Kesihatan Buntong, Persiaran Desa Rishah 2, 30100 Ipoh, Perak Darul Ridzuan, Malaysia

 

²Department of Family Medicine, Faculty of Medicine, Hospital Canselor Tuanku Muhriz,

Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak,

56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

 

³Clinical Research Centre Perak, Ministry of Health, 30100 Ipoh, Perak Darul Ridzuan, Malaysia

 

Received: 31 July 2019/Accepted: 29 January 2020

 

ABSTRACT

This is a case-control study conducted with diabetic patients in Kinta, Kampar and Larut-Matang-Selama districts of Perak, Malaysia. We intended to determine the factors contributing to the development of active tuberculosis among diabetes patients. Cases were culture-proven and registered in the Malaysian National Tuberculosis Surveillance Registry (MyTB) from 2012 to 2018. Controls were diabetes patients identified from the National Diabetes Registry and were matched with cases based on the clinic in which they were registered at a ratio of 1:1. 119 cases and 119 controls were included in this study. Multivariate analysis was used to identify clinical factors associated with tuberculosis. Patient had increased odds of having tuberculosis if they had higher glycaemic (HbA1c) levels (OR=1.41, 95% CI 0.22-0.96, p<0.001) or nephropathy (OR=8.91, 95% CI 2.31-34.05, p<0.001). The odds ratio was lower if they have diabetes for at or more than 5 years (OR=0.46, 95% CI 0.22-0.96, p=0.04) and older (OR=0.96, CI 0.92-0.99, p=0.02). In conclusion, this study suggests that routine screening for tuberculosis in patients with diabetes should consider the diabetic duration, glycemic control, presence of nephropathy, and age of the patient.

Keywords: Case-control study; diabetic associated factors; diabetic nephropathy; type 2 diabetes mellitus; tuberculosis

ABSTRAK

Ini adalah sebuah kajian kes kawalan yang melibatkan pesakit diabetes di daerah Kinta, Kampar dan Larut-Matang-Selama Perak, Malaysia. Kajian ini bertujuan untuk menentukan faktor yang menyumbang kepada perkembangan tuberkulosis aktif dalam kalangan pesakit diabetes. Kes bermaksud pesakit yang terbukti mendapat jangkitan tuberkulosis melalui kultur yang didaftarkan di Sistem Maklumat Tuberkulosis Kebangsaan (MyTB) dari tahun 2012 hingga 2018. Kawalan adalah pesakit diabetes yang dikenal pasti daripada Sistem Maklumat Diabetes Kebangsaan dan dipadankan dengan kes berdasarkan klinik dengan pesakit-pesakit tersebut didaftarkan dan dalam nisbah 1: 1. Kajian ini melibatkan 119 kes dan 119 kawalan. Analisis multivariat digunakan untuk mengenal pasti faktor klinikal yang berkaitan dengan tuberkulosis. Pesakit berisiko untuk tuberkulosis jika mereka mempunyai tahap glisemik (HbA1c) yang tinggi (OR=1.41, 95% CI 0.22-0.96, p<0.001) atau masalah ginjal (OR=8.91, 95% CI 2.31-34.05, p<0.001). Kebarangkalian pesakit untuk mendapat tuberkulosis berkurangan sekiranya mereka mempunyai diabetes 5 tahun atau lebih (OR=0.46, 95% CI 0.22-0.96, p=0.04) dan berumur (OR=0.96, CI 0.92-0.99, p=0.02). Kesimpulannya, kajian ini menunjukkan bahawa pemeriksaan rutin tuberkulosis pada pesakit diabetes harus mempertimbangkan tempoh diabetes, kawalan glisemik, keadaan ginjal dan usia pesakit.

Kata kunci: Diabetes; faktor berkaitan diabetes; kajian kes kawalan; masalah ginjal; tuberkulosis

 

REFERENCES

Abdelreheem I. Yousef, Mohamad F. Ismael, Ashraf E. Elshora & Heba E. Abdou. 2014. Pulmonary tuberculosis in patients with chronic renal failure at Zagazig University Hospitals. Egyptian Journal of Chest Diseases and Tuberculosis 63(1): 187-192.

Al-Efraij, K., Mota, L., Lunny, C., Schachter, M., Cook, V. & Johnston, J. 2015. Risk of active tuberculosis in chronic kidney disease: A systematic review and meta-analysis.  International Journal of Tuberculosis and Lung Disease 19(12): 1493-1499.

Alkabab, Y.M., Al-Abdely, H.M. & Heysell, S.K. 2015. Diabetes-related tuberculosis in the Middle East: An urgent need for regional research. International Journal of Infectious Disease 40: 64-70.

Blaser, N., Zahnd, C., Hermans, S., Salazar-Vizcaya, L., Estill, J., Morrow, C., Egger, M., Keiser, O. & Wood, R. 2016. Tuberculosis in Cape Town: An age-structured transmission model.  Epidemics 14: 54-61.

Chew, B.H., Mastura, I., Lee, P.Y., Wahyu, T.S., Cheong, A.T. & Zaiton, A. 2011. Ethnic differences in glycaemic control and complications: The adult diabetes control and management (ADCM), Malaysia. Medical Journal of Malaysia 66(3): 244-248.

Daniel, T.M. 2006. The history of tuberculosis. Respiratory Medicine 100(11): 1862-1870.

Disease Control Division, National Strategic Plan for Tuberculosis Control (2016-2020).  Ministry of Health Malaysia. 2016. http://www.moh.gov.my/index.php/.

Dobler, C.C., Flack, J.R. & Marks, G.B. 2012. Risk of tuberculosis among people with diabetes mellitus: An Australian nationwide cohort study. BMJ Open 2(1): e000666.

Dooley, K.E. & Chaisson, R.E. 2009. Tuberculosis and diabetes mellitus: Convergence of two epidemics. The Lancet Infectious Diseases 9(12): 737-746.

India Tuberculosis-Diabetes Study Group. 2013. Screening for patients with tuberculosis for diabetes mellitus in India. Tropical Medicine and International Health 18(5): 636-645.

Institute for Public Health (IPH) 2015. National Health and Morbidity Survey 2015 (NHMS 2015). Vol. II: Non-Communicable Diseases, Risk Factors & Other Health Problems.

International Diabetes Federation. 2019. International Diabetes Federation Western Pacific Members: Malaysia. https://www.idf.org/our-network/regions-members/western-pacific/members/108-malaysia.html. Accessed on 26 July 2019.

Ko, P-Y., Lin, S-D., Hsieh, M-C. & Chen, Y-C. 2017. Diabetes mellitus increased all-cause mortality rate among newly-diagnosed tuberculosis patients in an Asian population: A nationwide population-based study. Diabetes Research and Clinical Practice 133: 115-123.

Leung, C.C., Lam, T.H., Chan, W.M., Yew, W.W., Ho, K.S., Leung, G.M., Law, W.S., Tam, C.M., Chan, C.K. & Chang, K.C. 2008. Diabetic control and risk of tuberculosis: A cohort study. American Journal of Epidemiology 167(12): 1486-1494.

Lin, Y., Innes, A., Xu, L., Li, L., Chen, J., Hou, J., Mi, F., Kang, W. & Harries, A.D. 2015. Screening for patients with diabetes mellitus for tuberculosis in community health settings in China. Tropical Medicine and International Health 20(8): 1073-1080.

Malaysia Health Technology Assessment Section (MaHTAS). Management of tuberculosis. Putrajaya. Ministry of Health Malaysia, 2012.  http://www.moh.gov.my/attachments/8612.pdf.

Milburn, H., Ashman, N., Davies, P., Doffman, S., Drobniewski, F., Khoo, S., Ormerod, P., Ostermann, M. & Snelson, C. 2010. Guidelines for the prevention and management of Mycobacterium tuberculosis infection and disease in adult patients with chronic kidney disease. Thorax 65(6): 557-570.

Ostermann, M., Palchaudhuri, P., Riding, A., Begum, P. & Milburn, H.J. 2016. Incidence of tuberculosis is high in chronic kidney disease patients in South East England and drug resistance common. Renal Failure 38(2): 256-261.

Pealing, L., Wing, K., Mathur, R., Prieto-Merino, D., Smeeth, L. & Moore, D.A. 2015. Risk of tuberculosis in patients with diabetes: Population based cohort study using the UK Clinical Practice Research Datalink. BMC Medicine 13: 135.

Perak State Health Department. 2015. Tuberculosis Screening Report. Malaysia.

Shaw, A.C., Goldstein, D.R. & Montgomery, R.R. 2013. Age-dependent dysregulation of innate immunity. Natural Reviews Immunology 13(12): 875-887.

Swai, A.B., McLarty, D.G. & Mugusi, F. 1990. Tuberculosis in diabetic patients in Tanzania. Tropical Doctor 20(4): 147-150.

Swarna Nantha, Y. 2012. Influence of diabetes mellitus and risk factors in activating latent tuberculosis infection: A case for targeted screening in Malaysia. Medical Journal of Malaysia 67(5): 467-472.

Wang, Q., Ma, A., Han, X., Zhao, S., Cai, J., Ma, Y., Zhao, J., Wang, Y., Dong, H., Zhao, Z., Wei, L., Yu, T., Chen, P., Schouten, E.G., Kok, F.J. & Kapur, A. 2013. Prevalence of type 2 diabetes among newly detected pulmonary tuberculosis patients in China: A community based cohort study. PLoS ONE 8(12): e82660.

Wu, Z.Y., Guo, J.T., Huang, Y., Cai, E.M., Zhang, X., Pan, Q.C., Yuan, Z. &  Shen, X. 2016. Diabetes mellitus in patients with pulmonary tuberculosis in an aging population in Shanghai, China: Prevalence, clinical characteristics and outcomes. Journal of Diabetes and Its Complication 30(2): 237-241.

World Health Organization. 2019. Tuberculosis Country Profile: Malaysia 2017. World Health Organization. https://extranet.who.int/sree/Reports?op=Replet&name=%2FWHO_HQ_Reports%2FG2%2FPROD%2FEXT%2FTBCountryProfile&ISO2=MY&LAN=EN&outtype=html.

World Health Organization. 2018. Global Tuberculosis Report 2018: World Health Organization. https://www.who.int/tb/publications/global_report/en/.

World Health Organization. 2011. Collaborative framework for care and control of tuberculosis and diabetes. https://www.who.int/tb/publications/tb-diabetes-framework/en/.

 

*Corresponding author; email: drazimah@ppukm.ukm.edu.my