Asian Journal of Research in Infectious Diseases

Introduction: The rapid progression of the diabetes epidemic in low-income and middle-income countries threatens the efforts made in the fight against tuberculosis. This progression could even hinder the progress achieved toward meeting the Sustainable Development Goals aimed at ending the tuberculosis epidemic by 2030. The association between diabetes and tuberculosis presents certain particularities that have been highlighted by studies.

Objective: To assess the prevalence of diabetes among a population with tuberculosis admitted to the Infectious Diseases Department (SMIT) of Fann Teaching Hospital and to determine the main factors associated with death.

Methodology: A retrospective cross-sectional study, both analytical and descriptive, conducted over a five-year period (2018–2023). We performed a bivariate analysis to study the relationship between death and the different variables. The Chi-square independence test was used to search for statistical associations between these variables. When the p-value was less than 5%, we concluded that statistically significant associations existed.

Results: Out of 4,091 patients hospitalized during our study period, 868 presented with tuberculosis, representing a hospital frequency of 21.21%. We collected 34 cases of patients with a diabetes–tuberculosis association, corresponding to a proportional morbidity of 3.9%. A female predominance was noted (56%) with a sex ratio of 0.78. The mean age was 54 years. Half of the patients came from urban areas, and 41% were unemployed. Regarding comorbidities or underlying conditions, HIV co-infection was found in 32.35%, hypertension in 26.47%, and smoking in 9%. Previous hospitalization was reported in 58.82% of patients. Almost all patients had type 2 diabetes (94%), with diabetes evolving mostly for less than five years. Chronic degenerative complications were found in 12% of patients. The clinical presentation was insidious in 88% of patients, dominated by asthenia, followed by cough (65%) and fever (62%). Multifocal tuberculosis was the predominant form (53%), with pulmonary localization estimated at 85%. At admission, 47% of patients had fasting blood glucose above 1.26 g/L. Diabetes was poorly controlled in 66% of patients with HbA1c > 7%. The Xpert MTB/RIF test was positive in 87.7% (n=21) of tested patients, and sputum smear microscopy was positive in 70% (7 out of 10 tested patients). Thoracic imaging showed predominance of alveolar and interstitial syndromes, with a tendency toward bilaterality (60%) and lesion dissemination (36%). Regarding treatment, insulin therapy was initiated in 26% of cases before hospitalization and 20% during hospitalization. Anti-tuberculosis chemotherapy was administered to 91% of patients. The average hospital stay was 13 days. During hospitalization, 48% of patients developed non-infectious complications, particularly cardio-respiratory (18%). The mortality rate was 47.05%. Factors associated with death were mainly the duration of diabetes (p=0.016) and the presence of complications (p=0.000).

Conclusion: Tuberculosis is frequently associated with diabetes, especially in resource-limited countries, due to the growing number of diabetics in these regions. Consequently, the National Tuberculosis Control Program (PNT) recommends systematic screening for diabetes in all individuals with tuberculosis.