More than half of tuberculosis (TB) patients with newly diagnosed hyperglycemia at TB treatment initiation have unresolved hyperglycemia at the end of their follow-up period, according to data from a meta-analysis published in BMC Infectious Diseases. Findings suggest a need for diabetes mellitus (DM) screening at more frequent intervals during TB treatment.

Investigators conducted a meta-analysis of articles on TB-associated hyperglycemia with the primary objective of quantifying the reduction of newly diagnosed hyperglycemia burden in TB patients being treated over time. The secondary endpoint was to determine the burden of TB-associated hyperglycemia at the initial 3- to 6-month follow-up period.

There were 11 studies eligible for inclusion. Of the total study population (N=2418), 27.3% had newly detected hyperglycemia at baseline. The pooled percentage of unresolved, newly detected hyperglycemia at the conclusion of follow-up was 50% (95% CI, 36% to 64%) with high heterogeneity (I² =92.3%; P <.001). The total pooled proportion of unresolved hyperglycemia at 3 to 6 months of follow-up was 11% (95% CI, 7%-16%) with high heterogeneity (I² =93.83%; P <.001).

Study limitations included high heterogeneity, the small number of studies, and small sample sizes of single studies. Additionally, several studies measured hyperglycemia via fasting blood glucose alone, which can lead to underestimating impaired glucose tolerance by as much as 50% compared with the more accurate oral glucose tolerance test.


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Though there is a known link between TB and stress hyperglycemia, there has been no literature review to synthesize data on which patients with TB-associated hyperglycemia are at higher risk for developing DM and require more regular follow-up.

The study’s results indicate that if hyperglycemia is detected during the acute phase of TB, as many as 50% of patients may be overtreated for type 2 DM when their hyperglycemia can resolve spontaneously.

However, study authors highlighted that “the non-negligible proportion of unresolved cases of hyperglycemia at the end of follow-up underscores the necessity to repeat DM screening later within the course of TB treatment” to earlier identify patients at risk for unresolved hyperglycemia who would benefit from glucose-lowering therapies and reduce complications from type 2 DM.

Reference

Menon S, Rossi R, Dusabimana A, Zdraveska N, Bhattacharyya S, Francie J. The epidemiology of tuberculosis-associated hyperglycemia in individuals newly screened for type 2 diabetes mellitus: systematic review and meta-analysis. BMC Infect Dis. 2020;20(1):937. doi:10.1186/s12879-020-05512-7