• Rovina Ruslami, Raspati C Koesoemadinata, Nanny N M Soetedjo, Sofia Imaculata, Yuanita Gunawan, Hikmat Permana, Prayudi Santoso, Bachti Alisjahbana, Susan M McAllister, Daniel Grint, Julia A Critchley, Philip C Hill, and Reinout van Crevel.
• Infectious Disease Research Center, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Department of Biomedical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.
• Diabetes Res. Clin. Pract. 2021 Mar 1; 173: 108701.

AimsDiabetes mellitus (DM) is associated with worse tuberculosis (TB) treatment outcomes, especially among those with poor glycemic control. We examined whether a structured clinical algorithm could improve glycemic control in TB patients with DM.MethodsIn an open label randomized trial, TB-DM patients were randomized to scheduled counselling, glucose monitoring, and adjustment of medication using a structured clinical algorithm (intervention arm) or routine DM management (control arm), with glycated hemoglobin (HbA1c) at month 6 as the primary end point.ResultsWe randomized 150 pulmonary TB-DM patients (92% culture positive, 51.3% male, mean age 53 years). Baseline mean HbA1c was 11.0% in the intervention arm (n = 76) and 11.6% in the control arm (n = 74). At 6 months, HbA1c had decreased more in the intervention arm compared with the control arm (a difference of 1.82% HbA1c, 95% CI 0.82-2.83, p < 0.001). Five patients were hospitalized in the intervention arm and seven in the control arm. There was more hypoglycemia (35.0% vs 11.8%; p = 0.002) in the intervention arm. Two deaths occurred in the intervention arm, one due to cardiorespiratory failure and one because of suspected septic shock and multiorgan failure.ConclusionRegular monitoring and algorithmic adjustment of DM treatment led to improved glycemic control.Copyright © 2021 Elsevier B.V. All rights reserved.

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