Prognostic factors among TB and TB/DM comorbidity among patients on short course regimen within Nairobi and Kiambu counties in Kenya

Abstract

Background: The double burden of diabetes mellitus (DM) and pulmonary tuberculosis (TB) is one of the global health challenges. Studies done in different parts of the world indicate that 12%-44% of TB disease is associated with DM. In Kenya TB-DM co-morbidity data is scarce and is not readily available. In this study we set to determine the difference in treatment outcomes among TB and TB/DM comorbidity patients and their respective clinical and socio-demographic characteristics.

Objective: To determine prognostic factors among TB and TB/DM comorbidity among patients on short course regimen within Nairobi and Kiambu counties in Kenya.

Methods: We carried out a prospective cohort study of non-pregnant patients aged 15 years and above that tested positive for TB in two peri‑urban counties in Kenya between February 2014 and August 2015. Clinical and socio demographic data were obtained from a questionnaire and medical records of the National TB program patient data base at two, three, five and six months. The data consisted of TB status, HIV status, TB lineage, County, (Glucose, %HbA1c, creatinine) weight, height, BMI, regimen, sex, level of education, employment status, distance from health facility, number of cigarettes smoked, home size, and diet. Univariate analysis was then used to compare each potential risk factor in the TB and TB/DM patients by the Pearson x2 test of proportions or fisher exact test, as appropriate.

Results: DM prevalence (HbA1c > 6%) among TB infected patients was 37.2%. Regimen, employment status, alcohol intake, smoking, age and household size were some of the factors associated with DM among TB patients at p-value < 0.05. The number of cigarettes smoked per day and the value of the BUN were significant risk factors of developing DM among TB patients (p values = 0.045). Mean time to conversion from positive to negative was slightly higher for the TB-DM patients compared to the TB patents, though not statistically significant (p = 0.365).

Conclusion: Patients regimen, employment status, alcohol intake, smoking, age and are associated with DM among TB patients.