The Role of Type 2 Diabetes Mellitus on the Clinical Manifestation of Pulmonary Tuberculosis: A Study from Nepal

Introduction: Tuberculosis (TB) ranks as the seventh leading cause of death in Nepal. Similarly, the prevalence of Diabetes Mellitus (DM) has also shown an increasing trend in the country and it has been observed that diabetes is strongly associated with falling treatment outcome of tuberculosis. Hence, the association of tuberculosis with Type 2 Diabetes Mellitus (T2DM) might be higher than the assumption and it needs more attention as well as appropriate measures to improve treatment outcomes of both diseases. Aim: To determine the risk factors of T2DM comorbidity among TB patients in the Central Development Region of Nepal. Materials and Methods: A case-control study was conducted by administration of structured questionnaire interview among all forms of pulmonary tuberculosis patients. A total of 102 tuberculosis patients with T2DM who met the inclusion criteria were considered as cases and 306 non-diabetes tuberculosis cases were considered as controls. The study was conducted among the patients attending the tuberculosis treatment centres of all 19 districts of central Nepal. The risk factors of diabetes among tuberculosis patients was estimated by using unconditional multiple logistic regression, adjusted odds ratio and their 95% CI were measured. Results: This present study found that the risk factors of type 2 DM comorbidity among tuberculosis patients were; age >= 45 years (adj. OR=8.00, 95% CI: 4.21-15.21, p-value < 0.001), formal education (adj. OR=2.12, 95% CI: 1.08-4.15, p-value is 0.027), being underweight {Body Mass Index (BMI) < 18.5 Kg/m(2)} (adj. OR=2.61, 95% CI: 1.49-4.59, p-value < 0.001) and with diastolic blood pressure >= 80 (adj. OR=3.05, 95% CI: 1.72-5.43, p-value < 0.001). In addition, tuberculosis patients who visited more than two health facilities for diagnosis and treatments (adj. OR=2.06, 95% CI: 1.10-3.85, p-value is 0.024) and had medium level of knowledge (60-80%) on tuberculosis and diabetes (adj. OR=2.19, 95% CI: 1.09-4.39, p-value is 0.027) were more prone to having tuberculosis and diabetes. Conclusion: Tuberculosis with diabetes is strongly associated with age, education, hypertension comorbidity as well as delayed diagnosis. Therefore, regular DM screening program as well as timely health monitoring system of tuberculosis patients will enhance the tuberculosis control program in reducing TB burden from delayed cure in Nepal.