Factors​ Correlated​ to​ Pulmonary​ Tuberculosis ​among Diabetes​ Mellitus​ Patients ​in​ Chaiyaphum​ Province

Abstract

This an unmatched case-control study which aimed to identify factors related to pulmonary tuberculosis (PTB) among diabetes mellitus (DM) patients in Chaiyaphum Province. Data collection involved sourcing medical records and interviewed DM outpatients of diabetes clinics who were treated during the period 1 October 2008 to 30 September 2010. Clinics were selected randomly from government hospitals in fve districts of Chaiyaphum
Province, namely: Kaeng Khro, Phu Khieo, Kaset Somboon, Ban Thaen and Khon Sawan. The population selected for this research was 13,161 DM patients and two groups of 273 samples: 91PTB patients (the case group) and 182 non-TB patients (the control group). Descriptive statistics was applied
to identify the values of: mean, standard deviation, median, minimum, maximum, frequency and percentage. Thereafter, the relationship values of single variables were determined through univariate analyses: the Chi-square test and the crude odds ratio (OR). The variables found to have a P-value<0.25 were analyzed by multiple logistic regression to calculate the adjusted OR value (OR adj) at a 95% confdence interval (95% CI). A male to female ratio of 0.6 was recorded for the 13,161 DM patients studied. Of those patients, all were screened for PTB and 91 new PTB cases were recorded, equating to 6.9 PTB cases per 1,000 DM cases. Within the 91 PTB patients the ratio of male to female was 1.3. The univariate analysis showed that the risk factors related to PTB among diabetes patients with a signifcant P-value (P-value<0.05) were: being male (OR=1.74; 95% CI=1.01–2.98); having a level of hemoglobin A1c (HbA1c) exceeding 7.0 mg% (OR=3.63; 95% CI=1.97–6.70); having complications related to DM (OR=2.17; 95% CI =1.18–3.98); living in the same house as a TB patient (OR=4.87; 95% CI=1.49–18.36); having a close relative with TB (OR=5.41; 95% CI=2.21–14.10); and being a caregiver of TB patient/s (OR=4.17; 95% CI=1.47–12.76). At the same time, the analysis of multiple variable logistic regression with the control of age and sex variables found that the risk factors related to PTB among DM patients having a statistically signifcant P-value (<0.05) were: being male (ORadj=2.09; 95% CI=1.17–3.74); having a close relative with TB (ORadj=5.39; 95% CI=2.20–13.16); andhaving a level of HbA1c exceeding 7.0 mg% (ORadj=3.42; 95% CI=1.87–6.25)From the results of this study could be concluded that the prevalence of PTB in DM patients is ratherhigh. All of DM patients should be screened and educated about this. We have learned that the risk of PTB in DM patients can be a result of inadequate control of blood glucose level. Another important risk is having a close family member or household member with TB. Therefore, these patients are also advised to see a doctor to detect all tuberculosis cases. In addition, DM patients should seek treatment to control blood glucose levels, specifcally, to maintain a HbA1c level not higher than 7.0 mg%. These preventive measures will reduce the risk of PTB in DM patients. Finally, the epidemiological surveillance of PTB in DM patients should continue to be supported by local public health policies.