Efficacy of DOTS therapy in Pulmonary Tuberculosis with Diabetes Mellitus
Abstract
Diabetic persons are more susceptible to develop tuberculosis than non diabetics. What makes the diagnosis of combination difficult, is the fact that symptoms of complicating disease being masked by coexisting disease. Poor glycemic control helps in proliferation of tuberculosis and tuberculosis itself leads to poor glucose control. Thus both deteriorate each other. Directly Observed Treatment Short course has been found to be equally effective in patients with and without diabetes with pulmonary tuberculosis.
Method: The patients of either sex with pulmonary tuberculosis and associated diabetes mellitus admitted in medical ward excluding chronic cases. Pulmonary tuberculosis was diagnosed by examination of sputum for AFB and by clinical and radiological assessment. Diabetes mellitus was diagnosed from history, previous records and blood examination as per ADA criteria.
Results: The cure rate was 82% in diabetic group and 86% in non-diabetic group with failure rate of 6% and 4% in diabetic group and non diabetic group respectively.
Conclusion : Patients with pulmonary tuberculosis having age more than 40yrs and lower lobe lesions should be subjected to O.G.T. to rule out occult diabetes.
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References
2. RNTCP Operational Guidelines. 1999. Govt. of India.
3. Guptan A and Shah A. Tuberculosis and Diabetes: An Appraisal. Ind. J. Tub, 2000; 47(3): 3-8.
4. American Diabetes Association: Clinical Practice Recommendations 2007. Diabetes Care, 2000; (30)S4.
5. Oluboyo PO, Erasmus RT. The significance of glucose intolerance in pulmonary tuberculosis. Tubercle 1990;71:135-8.[PubMed]
6. Lin S, Shen M, Sun Y. Epidemiological characteristics of tuberculosis patients complicated with diabetes in Shanghai. Zhonghua Jie He He Hu Xi Za Zhi. 1998; 21 (8): 504-6. [PubMed]
7. Fernandez L, Hosker SN, Mesquita AM. Diabetes mellitus in Pulmonary tuberculosis. JAPI, 2004; 45(10): 774-776.
8. Jawad, F., Shera, A.S., Memom, R and Ansari, G. Glucose Intolerance in pulmonary tuberculosis. J. Park, Med. Assoc. 1995 Sept.; 45(9): 237-8.[PubMed]
9. Desmukh M.D, Master T.8., David J.C. and Tripathi S. Diabetes complicated by Pulmonary tuberculosis. Diabetic Asso. of India, 1996; 497.
10. Ross J.D.. Progress of tuberculous diabetics coming under supervision during years 1993-95 Tubercle. 1995; 54:130.
11. Tripathy S.R., Kar, K.P., Chakrabarty. D.C. and Mazumdar A.K.. Diabetes mellitus and Tuberculosis - A prospective study. I.J. Tuberculosis. 1984; 31:122-125.
12. Ziskind MM, Weill H, Buechner HA, Brown M: Recognition of distinctive radiologic patterns in diffuse pulmonary disease. Arch Intern Med.;114(1):108-112.[PubMed]
13. Khanna B.K.: Pulmonary tuberculosis diabetes mellitus, .JIMA. 2004 May; 50(9): 407-12.[PubMed]
14. Gupta, Nigam, Tuberculosis and Diabetes Mellitus : Merging Epidemics, JAPI. 2009 May; 57:399-402.[PubMed]
15. Hadden DR. Glucose, free fatty acid, and insulin interrelations in kwashiorkor and marasmus .Lancet. 1967 Sep 16;2(7516):589–592.[PubMed]
16. Kekkaku. Clinical and experimental studies on lung infection in diabetes mellitus with special reference to pulmonary tuberculosis 1970 Sep;45(9):273-81.[PubMed]
17. BanuRekhaV.V, Balasubramanian R, Swaminathan S, Ramachandran R FathimaRahman, V. Sundaram, K.Thyagarajan et al Sputum conversion at the end of intensive phase of Category-1 regimen in the treatment of pulmonary tuberculosis patients withdiabetes mellitus or HIV infection: An analysis of risk factors. Indian J Med Res , 2007; 126: 452-458. [PubMed]
18. Kotokey R. K., Bhattacharya D. N., Das P., Azad A. K., A study of efficacy of DOTS in pulmonary tuberculosis Patients with associated diabetes , Lung India. 2007;24:58-60.
19. Singla R, Khan N, Al-Sharif N, Ai-Sayegh MO, Shaikh MA, Osman MM. Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients. Int J Tuberc Lung Dis. 2008;10(1):74-9.
20. Nissapatorn V, Kuppusamy I, Jamaiah I. Tuberculosis in diabetic patients: a clinical perspective, southeast Asian J Trop Med Public Health. 2004; 36(suppl 4): 213-220.[PubMed]
21. Kant L. Diabetes mellitus-Tuberculosis: thebrewing double trouble. Indian J Tuberc 2003;50(4): 183-4.
22. Helen S Cox, Martha Morrow, Peter W Deutschmann. Long term efficacy of DOTS regimens for tuberculosis: systematic review BMJ 2008; 336 : 484 doi: 10.1136/bmj.39463.640787. BE (Published 4 February 2008).
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