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PREVALENCE OF PRE-DIABETES OR DIABETES AMONG
TUBERCULOSIS PATIENTS IN NORTHEAST OF CHINA
Mubinjonov Aziz Daminovich
Jarkinova Marjona G'olibjon qizi
Norqulov Mehrojiddin Mahammad o'g'li
Samarkand State Medical University
Uzbekistan. Samarkand
https://doi.org/10.5281/zenodo.13734284
Annotation:
tuberculosis (TB) and diabetes are both severe chronic
diseases. They could begin simultaneously and also aggravate each other. That is
why it is very significant to explore the interaction between two diseases. The
goal of this study is to investigate the prevalence rate of TB patients combined
with pre-diabetes (impaired fasting blood glucose) or diabetes. The data show
that the prevalence rate of TB patients suffering from pre-diabetes or diabetes is
12,4 % and 13,3 %, respectively, which are higher than in general population.
These results indicate that TB may play an important role in inducing or
promoting the development of diabetes. Therefore, further evidence of the
connection between TB and diabetes may provide a new strategy of prevention
and treatment of both diseases.
Key words:
TB, pre-diabetes, diabetes, combination.
Recent data for the global burden of disease reflect major demographic and
lifestyle changes, leading to a rise in non-communicable diseases. Most countries
with high levels of tuberculosis (TB) face a large comorbidity burden from both
non-communicable and communicable diseases. As the World Health
Organization (WHO) and the International Organization against TB and Lung
Disease raised a cooperation framework in 2011, which proposed merger care
and disease control in diabetic patients with TB, encouraging collaborative
research and bidirectional screening for two diseases, the relationship between
diabetes and TB or synergies caused more and more concern [1, 2]. Both
diabetes and TB are severe chronic diseases. They could outset simultaneously
and motivate each other as well. The traditional specific therapeutic methods
have failed in management and control of these diseases [3]. Most studies have
proposed that diabetes is one of the important risk factors for TB. Diabetes can
not only lead to more severe mycobacterium infection, high mortality and low
cure rate, but also can lead to a recurrence and reproduce of TB [4, 5]. However,
there is less research on TB merger pre-diabetes and diabetes, especially the
lack of effective methods in disease control and treatment. Therefore, concerted
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therapy method is urgently needs for this situation. The need for sustained and
increased funding for these initiatives is greater than ever and requires
increased research commitment. The prevalence of pre-diabetes and diabetes is
9,7 % and 15,5 %, respectively in China [6]. Among 3017 people in Nangang
district of Harbin in Heilongjiang province, the prevalence for pre-diabetes is
3,75 %, and for diabetes is 10,21 % [7]. All data above is the study of natural
populations. According to the diagnostic criteria for diabetes in China (1999
WHO diagnostic criteria), all TB patients will be classified as TB patients, TB
patients combined pre-diabetes and TB patients combined diabetes. We
investigate the prevalence of TB combined with prediabetes or diabetes,
providing the theoretical basis of TB and diabetes interaction, which would be
helpful to control TB and reduce mortality.
Materials and methods
Study Population To analyze the incidence of TB in
Heilongjiang province, we investigated the cases of TB patients from 2001–
2011, the data of which is from Heilongjiang province hospital. Random
collected 421 clinical TB cases of March ~ May 2011 from Heilongjiang province
hospital, and weed out the cases below normal blood glucose levels, then 404
cases are included in this study. According to the diagnostic criteria for diabetes
in China (1999 WHO diagnostic criteria), all TB patients will be classified as
three group, single TB patients group with blood glucose 3,9~6,1 mmol/L, TB
patients combined prediabetes group with blood glucose 6,1~7,0 mmol/L, and
TB patients combined diabetes group with blood glucose more than 7,0 mmol/L.
Statistical Analysis SPSS16.0 statistical software is applied to processed all data.
The prevalence of TB patients combined prediabetes or diabetes are analyzed
with 95 % confidence intervals (95 % CI). Ethical Support All information
collected in this study have approved by infectious hospital of Heilongjiang
province and Harbin Medical University ethics committee.
Results
Case numbers of TB and pulmonary TB in Heilongjiang province To
analyze the prevalence of TB in Heilongjiang province, we first collect TB cases
from 2001–2011 in Heilongjiang province hospital. As shown in Figure 1, the
numbers of TB cases increase gradually since 2001, and fall slightly at 2011, but
still at a high level. Pulmonary TB is the most important composition of TB, and
its incidence trend is the similar to TB, also raise gradually from 2001~2011.
Total 404 TB patients cases, 264 cases of male and 140 cases of female, are
collected in this study, with an average age of 42,02±17,518. According to the
fasting blood glucose levels, all TB patients will be classified as three group,
single TB patients group with blood glucose 3,9~6,1 mmol/L, TB patients
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combined pre-diabetes group with blood glucose 6,1~7,0 mmol/L, and TB
patients combined diabetes group with blood glucose more than 7,0 mmol/L.
We investigate the prevalence of TB combined with pre-diabetes or diabetes,
and the results are shown in Table 1. The morbidity of TB patients with pre-
diabetes is 12.4% (95 % CI 7,3%-17,5 %), and the morbidity of TB patients with
diabetes is 13,3 % (95 % CI 7,9 %-18,7 %). Table Prevalence of TB patients
combined pre-diabetes or diabetes Group (n=404) Case number Morbidity 95 %
CI TB 296 TB+Pre-D 50 12,4 % 7,3 %-17,5 % TB+D 58 14,4 % 7,9 %-18,7 %
Notes: TB represents single TB patients, TB+Pre-D represents TB patients
combined pre-diabetes, and TB+D represents TB patients combined diabetes.
Discussion
TB is a major public health threat in the world, nearly a third people
infected by mycobacterium TB, and the numbers still develop with a 9,4 million
increase every year. When confronted with TB, a chronic and long term illness,
households face not only a physical and mental burden, but also an economic
burden, which commonly includes the direct costs of treatment, medicine,
informal payments, and the indirect costs of a reduction in their ability to
generate income [8], especially in low- and middle-income countries. The
prevention of TB relies mainly on early identification, prevention of latent TB
infection reactivation, and infection control measures [9]. In this study, the data
show that prevalence of TB patients in Heilongjiang province increase gradually
from 2001–2011, so the trend of Pulmonary TB, the most important
composition of TB. Diabetes is also a chronic disease with a develop people
suffering from it. The prevalence of diabetes usually occur with territoriality due
to development of economic, custom of living or eating. The rising prevalence of
diabetes thus poses an increasing risk for the control and prevention of TB [10].
As such, while this case study is focused on a single city in a developing health
care system. TB and diabetes have strong co-morbidities, with both the
incidence and severity of being affected by each other [11, 12], the causes are
still not completely known. We performed this population-based study to
investigate morbidity rates of pre-diabetes or diabetes in TB patients, thus
provide a theoretical basis data for further exploring the interaction between TB
and diabetes. In this study, the morbidity of TB patients with pre-diabetes is
12,4 % (95 % CI 7,3 %-17,5 %), and the standardized rate is 15,0 %, which is 9,7
% higher than China's domestic normal population in 2010 [6], 3,75 % higher
than the community population in Nangang district of Harbin in Heilongjiang
province in 2009, suggesting TB facilitate the occurrence of pre-diabetes.
Meanwhile, the morbidity of TB patients with diabetes is 14,4 % (95 % CI 7,9-
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18,7 %) in our study, and the standardized rate is 12,6 %, within the higher level
of normal incidence (2 %-12,9 %) [13, 14]. In addition, this morbidity is also
higher than 10,21 % from the community population in Nangang district of
Harbin in Heilongjiang province in 2009, further indicating TB facilitate the
occurrence of diabetes. Total 255 TB patients, 60,6 % of the whole accounted for
survey, are investigated with the age from 24~60 years old. Among them, there
are 106 TB patients combined prediabetes and diabetes, and 73 patients are the
age of 24~60 years old, which is a high percentage (67,6 %) of total cases in
study. Therefore, we should focus on the publicity and education of synergy
diseases for the patients aged from 24~60 years old, further to decrease the
morbidity of synergy diseases. Currently, new therapy is urgently need to treat
the combination diseases between TB and diabetes, and people have tried many
methods. It is said that application of IFNs play a supporting role for treatment
of patients with refractory multiple drug-resistant TB combined diabetes,
besides antibiotic treatment [15]. And our study preliminarily analyze the links
between TB and diabetes, this association may provide a new strategy
concerning the prevention and treatment of both diseases. In conclusion, our
study suggest that the prevalence rate of TB patients suffering from pre-diabetes
or diabetes is higher than general people.
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