• V Mave, S Meshram, R Lokhande, D Kadam, S Dharmshale, R Bharadwaj, A Kagal, N Pradhan, S Deshmukh, S Atre, T Sahasrabudhe, M Barthwal, A Kakrani, V Kulkarni, S Raskar, N Suryavanshi, R Shivakoti, S Chon, E Selvin, A Gupte, A Gupta, N Gupte, and J E Golub.
• Byramjee-Jeejeebhoy Medical College-Johns Hopkins University Clinical Research Site, Pune, India; Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
• Int. J. Tuberc. Lung Dis. 2017 Dec 1; 21 (12): 1280-1287.

SettingPune, India.ObjectivesTo estimate the prevalence and risk factors of pre-diabetes mellitus (DM) and DM, and its associations with the clinical presentation of tuberculosis (TB).DesignScreening 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.ResultsAmong 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 9 days to TB detection.ConclusionOver 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.

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