Jurnal Dr Harsono-2

7/28/2019 Jurnal Dr Harsono-2

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The Role Of Diabetes

Co-Morbidity forTuberculosis

Treatment OutcomesDaniel Faurholt-Jepsen, Nyagosya Range, GeorgePraygod, Jeremiah Kidola, Maria Faurholt-Jepsen,

Martine G, Aabye, John Changalucha, Dirk L.Christensen, Torben Martinussen, Henrik Krarup, Danie

R Witte, Ase B Andersen, Henrik Friis (2012:12)


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Abstract

Background :

To study association between diabetes & TB

Methods :

Linear mixed-effect model (repeatedmeasurement)

Results :

1,3 kg & 1,0 kg; 0,6 g/dL & 0,5 g/dL

Conclussion :

TB patients with diabetes experience delayrecovery of bodymass and hemoglobin


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Background

Due to the association between diabetesand pulmonary TB, diabetes may threatenthe control of TB. In a prospective cohortstudy nested in a nutrition trial, we

investigated the role of diabetes onchanges in anthropometry, grip strength,and clinical parameters over a five monthsfol


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Methods

Cohort study, 2 large randomized, double blind,controlled nutrition interventional study with all patientdiagnosed and treated for TB according to internationalguidelines.

Measurement :

TB patient : use Spot-morning-spot sample

Weight & height : barefoot, minimal clothing

Waist circumference : lower costa-iliac crest

AFA & AMA : use TST & MUAC

Grip strength : digital hand dynamometer

Diabetes : FBG > 108 mg/dL ; 2 h pp > 198 mg/dL

HIV : ELISA

CD4 : flow cytometry


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Results

Of 1205 TB patients, the mean (standarddeviation) age was 36,6 (13,0) years, 40,5%were females, 48,9% were HIV co-infected,and 16,3% had diabetes. TB patient with

diabetes co-morbidity experienced a lowerweight gain at two (1,3kg) and five months(1,0kg). Similarly, the increase in the level ofhemoglobin was lower among TB with

diabetes co-morbidity after two (0,6g/dL)and five months (0,5 g/dL)of TBtreatment, respectively


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Backgroundcharacteristics

Patient w/odiabetes

Patient w/diabetes

p

Age (SD) 36,3 (12,8) 38,0 (13,8) 0,083

Female sex 404 (40,1) 89 (45,2) 0,183

HIV infection 507 (50,3) 97 (49,2) 0,786TB status

PTB- 339 (33,6) 83 (32,0) 0,65

PTB+ 669 (66,4) 134 (68,0) *

Ethnic Group

Msukuma tribe 459 (45,6) 94 (47,7) 0,582

Other tribe 584 (54,4) 103 (52,3) *


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Patient w/odiabetes

Patient w/diabetes

P

Marital status

Single 249 (24,9) 42 (21,5) 0,605

Married 528 (52,8) 108 (55,4)Divorced 223 (22,3) 45 (23,1)

Occupation

Farmer/fisherman 394 (39,2) 75 (38,3) 0,974

Employed 356 (35,4) 74 (37,8) *

Housewife 120 (11,9) 23 (11,7) *

Unemployed 51 (5,1) 9 (4,6) *


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Patient w/odiabetes

Patient w/diabetes

P

Religion * * *

Christian 741 (73,8) 155 (78,7) 0.191

Muslim 223 (22,1) 38 (19,3) *Smoking * * *

Never 675 (82,9) 139 (17,1) 0.60

Past smoker 110 (85,9) 18 (14,1) *

Current smoker 216 (84,7) 39 (15,3) *

Take alcohol * * *

No 533 (82,9) 110 (17,1)

Yes 475 (84,5) 87 (15,5) *


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Patients w/odiabetes

Patients w/diabetes

P

Weight, kg * * *

Baseline 51,8 53,3 *

2 months 54,8 55,1 *Increase 3,0 1,7 *

Difference 1,3 * 0,001

5 months 57,1 57,7 *

Increase 5,3 4,3 *



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Patient w/odiabetes

Patient w/diabetes

P

BMI, kg/m2 * * *


2 months 19,8 19,9 *Increase 1,1 0,6 *


5 months 20,7 20,9 *

Increase 1,9 1,6 *



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Patients w/diabetes

P

Waist circumference, cm * * *


2 months 74,5 75,8 *Increase 2,4 2,1 *


5 months 76,3 77,8 *

Increase 4,2 4,1 *

Difference 0,1 * 0.697


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Patients w/diabetes

P

AMA, mm2 * * *


2 months 37,2 37,4 *Increase 2,7 1,7 *


5 months 40,7 41,0 *

Increase 6,2 5,4 *



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Patients w/diabetes

P

AFA, mm2 * * *

Baseline 8,1 8,3 *

2 months 9,2 9,0 *Increase 1,1 0,8 *

Difference 0.4 * 0,297

5 months 10,4 10,4 *

Increase 2,3 2,1 *



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Patients w/diabetes

P

Grip Strength,kg

* * *


2 months 27,6 26,8 *

Increase 1,8 1,6 *


5 months 30,5 29,6 *

Increase 4,7 4,4 *


Ch i h l bi


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Change in hemoglobinlevel


Patients w/diabetes

P

Hemoglobin,g/dL

* * *

Baseline 10.8 10.7 *

2 months 12.3 11.7 *

Increase 1.6 1.0 *

Difference 0.6 *


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Patients w/diabetes

P

Whitebloodcell count

* * *

Baseline 6.4 6.8 *

2 months 4.7 5.0 *

Increase -1.7 -1.7 *

Difference 0.02 * 0.918

5 months 4.3 4.6 *


Difference -0.03 * 0.889


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Patients w/diabetes

P

Neutrophilcount

* * *

Baseline 4.1 4.6 *

2 months 2.3 2.6 *



5 months 1.8 2.2 *




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Patients w/diabetes

P

CD4 count * * *

Baseline 425.9 409.2 *

2 months 477.5 435.1 *Increase 51.7 25.9 *


5 months 436.2 396.6 *

Increase 10.3 -12.5 *



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Mean weight increase

0 1 2 3 4 5

non diabetes2

diabetes


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Mean hemoglobin

1 2 3 4 5

non diabetes

diabetes


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Discussion

Diabetes co-morbidity was associated withdelayed recovery of weight andhemoglobin level within the first two and 5months of TB treatment

Functional recovery based on grip strengthnot affected by diabetes

Low level of hemoglobin at baseline areprimarily inflamation-induced anemia fromon-going HIV and TB infection, thehemoglobin level is expected to rise duringrecovery


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The differences did not depend on TB status

On average the participants gained threeand five kg over the two and five months

treatment period, but diabetes patient hada one kg weight deficit

Fluctuations in CD4 level (increase in first twomonths) were not effected by diabetes co-

morbiditiy.


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Conclussion

TB patients initiating TB treatment withdiabetes co-morbidity may experienceslower recovery from their TB disease

This study focused on general outcomessuch as anthropometry and hemoglobin

A quick functional recovery lead to soonerreturn to work, and thus the delay may not

only have beneficial health outcomes, butalso economically consequences for lowincome families burdened by TB

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