Prevalence of dysglycemia and clinical presentation of pulmonary tuberculosis in Western India

SETTING: Pune, India. OBJECTIVES: To estimate the prevalence and risk factors of pre-diabetes mellitus (DM) and DM, and its associations with the clinical presentation of tuberculosis (TB). DESIGN: Screening for DM was conducted among adults (age >= 18 years) with confirmed TB between December 2013 and January 2017. We used multinomial-regression to evaluate the risk factors for pre-DM (glycated hemoglobin [HbA1c] >= 5.7-6.5% or fasting glucose 100-125 mg/dl) and DM (HbA1c >= 6.5% or fasting glucose >= 126 mg/dl or random blood glucose > 200 mg/dl or self-reported DM history/treatment) and the association of dysglycemia with the severity of TB disease. RESULTS: Among 1793 participants screened, 890 (50%) had microbiologically confirmed TB. Of these, 33% had pre-DM and 18% had DM; 41% were newly diagnosed. The median HbA1c level among newly diagnosed DM was 7.0% vs. 10.3% among known DM(P < 0.001). DM(adjusted OR [aOR] 4.94, 95% CI 2.33-10.48) and each per cent increase in HbA1c (aOR 1.42, 95% CI 1.01-2.01) was associated with >1+smear grade or 69 days to TB detection. CONCLUSION: Over half of newly diagnosed TB patients had DM or pre-DM. DM and increasing dysglycemia was associated with higher bacterial burden at TB diagnosis, potentially indicating a higher risk of TB transmission to close contacts.