Elevated blood glucose and unfavourable tuberculosis treatment outcomes in a low-income setting: findings from a prospective cohort study in Eswatini
Introduction The increasing burden of diabetes mellitus in low- and middle-income countries negatively impacts tuberculosis control. To understand this dual burden in Eswatini, we describe the prevalence and predictors of elevated baseline blood glucose and unfavourable tuberculosis treatment outcom...
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BMJ Publishing Group
2025-01-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/3/1/e001407.full |
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| author | Diederick E Grobbee Kerstin Klipstein-Grobusch Kennedy Otwombe Victor Williams Alinda G Vos-Seda Marianne Calnan Colani S Ngwenya Samson Haumba Lindiwe Mdluli-Dlamini |
| author_facet | Diederick E Grobbee Kerstin Klipstein-Grobusch Kennedy Otwombe Victor Williams Alinda G Vos-Seda Marianne Calnan Colani S Ngwenya Samson Haumba Lindiwe Mdluli-Dlamini |
| author_sort | Diederick E Grobbee |
| collection | DOAJ |
| description | Introduction The increasing burden of diabetes mellitus in low- and middle-income countries negatively impacts tuberculosis control. To understand this dual burden in Eswatini, we describe the prevalence and predictors of elevated baseline blood glucose and unfavourable tuberculosis treatment outcomes.Methods We conducted a prospective cohort study at 11 health facilities in Eswatini and included adults ≥18 years commencing tuberculosis treatment. Blood glucose measurements were taken at baseline, months 2 and 5, and patients’ sociodemographic and clinical data were extracted. We computed the prevalence of elevated blood glucose and used logistic regression to determine the predictors of elevated baseline blood glucose and unfavourable treatment outcomes.Results Of 369 consecutively enrolled patients, the mean age was 38.4 (SD 12.9) years, and 202 (54.7%) were males. The prevalence of elevated baseline blood glucose was 8.0% (95% CI: 5.5, 11.3); 8.9% in males (95% CI: 5.6, 13.9); highest at ≥55 years (13.6%; 95% CI: 6.2, 27.3) and in patients with reactive HIV at 9.5% (95% CI: 6.5, 13.7). A family history of diabetes mellitus (adjusted OR (AOR) 2.80; 95% CI: 1.08, 7.32) and a reactive HIV status (AOR 4.62; 95% CI: 1.06, 20.11) significantly predicted elevated baseline blood glucose. Three-quarters (n=276, 75.4%) had a favourable tuberculosis treatment outcome; more males (n=59, 66%) had an unfavourable treatment outcome (p=0.020), the most common unfavourable outcome being death (n=34, 9.2%). Hypertension (AOR 4.84; 95% CI: 1.48, 15.7), unemployment (AOR 2.01; 95% CI: 1.08, 3.71) and high school education (AOR 0.32; 95% CI: 0.16, 0.64) were associated with unfavourable treatment outcome.Conclusion Our study shows the need to optimise care for patients receiving treatment for tuberculosis by integrating screening for and treatment of diabetes and hypertension, prioritising males, those aged ≥55 years and those with a reactive HIV status to limit unfavourable outcomes and death. |
| format | Article |
| id | doaj-art-f80e370994cb484f9899c1161df34025 |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-f80e370994cb484f9899c1161df340252025-01-17T07:55:10ZengBMJ Publishing GroupBMJ Public Health2753-42942025-01-013110.1136/bmjph-2024-001407Elevated blood glucose and unfavourable tuberculosis treatment outcomes in a low-income setting: findings from a prospective cohort study in EswatiniDiederick E Grobbee0Kerstin Klipstein-Grobusch1Kennedy Otwombe2Victor Williams3Alinda G Vos-Seda4Marianne Calnan5Colani S Ngwenya6Samson Haumba7Lindiwe Mdluli-Dlamini8Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The NetherlandsJulius Global Health, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands1 Perinatal HIV Research Unit (PHRU), University of the Witwatersrand Johannesburg, Diepkloof, Gauteng, South AfricaSchool of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South AfricaJulius Global Health, Department of Global Public Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The NetherlandsUniversity Research Co LLC, Manila, PhilippinesCenter for Global Health Practice and Impact, Georgetown University, Mbabane, EswatiniCenter for Global Health Practice and Impact, Georgetown University, Mbabane, EswatiniNational Tuberculosis Control Program, Manzini, EswatiniIntroduction The increasing burden of diabetes mellitus in low- and middle-income countries negatively impacts tuberculosis control. To understand this dual burden in Eswatini, we describe the prevalence and predictors of elevated baseline blood glucose and unfavourable tuberculosis treatment outcomes.Methods We conducted a prospective cohort study at 11 health facilities in Eswatini and included adults ≥18 years commencing tuberculosis treatment. Blood glucose measurements were taken at baseline, months 2 and 5, and patients’ sociodemographic and clinical data were extracted. We computed the prevalence of elevated blood glucose and used logistic regression to determine the predictors of elevated baseline blood glucose and unfavourable treatment outcomes.Results Of 369 consecutively enrolled patients, the mean age was 38.4 (SD 12.9) years, and 202 (54.7%) were males. The prevalence of elevated baseline blood glucose was 8.0% (95% CI: 5.5, 11.3); 8.9% in males (95% CI: 5.6, 13.9); highest at ≥55 years (13.6%; 95% CI: 6.2, 27.3) and in patients with reactive HIV at 9.5% (95% CI: 6.5, 13.7). A family history of diabetes mellitus (adjusted OR (AOR) 2.80; 95% CI: 1.08, 7.32) and a reactive HIV status (AOR 4.62; 95% CI: 1.06, 20.11) significantly predicted elevated baseline blood glucose. Three-quarters (n=276, 75.4%) had a favourable tuberculosis treatment outcome; more males (n=59, 66%) had an unfavourable treatment outcome (p=0.020), the most common unfavourable outcome being death (n=34, 9.2%). Hypertension (AOR 4.84; 95% CI: 1.48, 15.7), unemployment (AOR 2.01; 95% CI: 1.08, 3.71) and high school education (AOR 0.32; 95% CI: 0.16, 0.64) were associated with unfavourable treatment outcome.Conclusion Our study shows the need to optimise care for patients receiving treatment for tuberculosis by integrating screening for and treatment of diabetes and hypertension, prioritising males, those aged ≥55 years and those with a reactive HIV status to limit unfavourable outcomes and death.https://bmjpublichealth.bmj.com/content/3/1/e001407.full |
| spellingShingle | Diederick E Grobbee Kerstin Klipstein-Grobusch Kennedy Otwombe Victor Williams Alinda G Vos-Seda Marianne Calnan Colani S Ngwenya Samson Haumba Lindiwe Mdluli-Dlamini Elevated blood glucose and unfavourable tuberculosis treatment outcomes in a low-income setting: findings from a prospective cohort study in Eswatini BMJ Public Health |
| title | Elevated blood glucose and unfavourable tuberculosis treatment outcomes in a low-income setting: findings from a prospective cohort study in Eswatini |
| title_full | Elevated blood glucose and unfavourable tuberculosis treatment outcomes in a low-income setting: findings from a prospective cohort study in Eswatini |
| title_fullStr | Elevated blood glucose and unfavourable tuberculosis treatment outcomes in a low-income setting: findings from a prospective cohort study in Eswatini |
| title_full_unstemmed | Elevated blood glucose and unfavourable tuberculosis treatment outcomes in a low-income setting: findings from a prospective cohort study in Eswatini |
| title_short | Elevated blood glucose and unfavourable tuberculosis treatment outcomes in a low-income setting: findings from a prospective cohort study in Eswatini |
| title_sort | elevated blood glucose and unfavourable tuberculosis treatment outcomes in a low income setting findings from a prospective cohort study in eswatini |
| url | https://bmjpublichealth.bmj.com/content/3/1/e001407.full |
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