Impact of Glycemic Control on Tuberculosis Treatment Outcomes in Patients With Diabetes Mellitus: A Retrospective Audit
https://doi.org/10.15605/jafes.041.S1
- Author:
Chitra Devi Balasubramaniyam
1
;
Mohammad Ulilamri Tukiman
1
;
Yusniza Yusoff
2
;
Mohammad Nur Syafiq Mohammad Azman
1
;
Choo Jia Qing
1
Author Information
1. Department of Internal Medicine, Hospital Sungai Buloh
2. Endocrine Unit, Department of Internal Medicine, Hospital Sungai Buloh
- Publication Type:Journal Article
- MeSH:
Humans;
Glycemic Control;
Retrospective Studies;
Diabetes Mellitus;
Treatment Outcome;
Tuberculosis
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):37-38
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Diabetes mellitus (DM) is a significant comorbidity
associated with adverse tuberculosis (TB) treatment
outcomes and remains an ongoing clinical challenge.
Chronic hyperglycemia impairs host immune responses,
particularly macrophage function, leading to delayed
bacillary clearance. This contributes to poorer outcomes,
including delayed sputum conversion, prolonged
treatment duration, relapse, and increased mortality. Poor
glycemic control is a key modifiable factor influencing
these outcomes. This study aimed to evaluate the impact
of glycemic control at diagnosis on TB treatment outcomes
in a Malaysian cohort.
Methodology:A retrospective cross-sectional audit was conducted using
the TB clinic registry at Hospital Sungai Buloh from 2022
to 2025. Adult patients (≥18 years) with confirmed TB (any
form) and DM (Type 1 or Type 2) with complete records
were included. Of 241 patients screened, 131 were included
after exclusions due to incomplete records (29.9%), transfer
(29.9%), loss to follow-up (19.9%), and drug-resistant TB
(2.9%). Data collected included demographics, hemoglobin
A1c (HbA1c) at diagnosis, sputum conversion duration,
treatment duration, type of DM therapy, and clinical
outcomes.
Results:The cohort had a mean age of 53 years, with 97% having
Type 2 DM.
Mean HbA1c at diagnosis was 10.5%. Poorer glycemic
control was associated with delayed sputum conversion.
Patients who achieved sputum conversion by 8 weeks had
an average HbA1c of 9.6%, compared to 11.8% in those
with delayed conversion. Longer treatment duration was
associated with higher HbA1c (mean 10.5, 8.6, and 11.8%
for 6-, 12-, and 18-month regimens, respectively). Relapse
analysis demonstrated a trend towards higher HbA1c with
increasing relapse episodes (11.2, 13.75, and 14.5% for one, two, and three relapses, respectively). Overall mortality
was 17% (22/131), with markedly higher mean HbA1c in
deceased patients compared to survivors (16.0% vs 10.5%).
Conclusion:Poor glycemic control at TB diagnosis is associated with
delayed sputum conversion, prolonged treatment duration,
and increased mortality. These findings are consistent with
regional evidence, including a South Asian systematic
review (Gautam et al., 2021), demonstrating higher mortality
and treatment failure in patients with TB and DM. Early
and aggressive optimization of glycemic control, alongside
standard anti-TB therapy, is essential to improve outcomes.
- Full text:2026072908420695537EP_A034.pdf
