• Ruveena Kaur, Tobias Egli, Jennifer Paynter, Rinki Murphy, Lavinia Perumal, Arier Lee, Adrian Harrison, Tim Christmas, Chris Lewis, and Mitzi Nisbet.
• Respiratory Department, Auckland District Health Board, Auckland, New Zealand.
• Intern Med J. 2023 Sep 1; 53 (9): 158815941588-1594.

BackgroundDiabetes mellitus (DM) triples a person's risk of active tuberculosis (TB) and is associated with increased mortality. It is unclear whether diabetes status and/or the associated renal dysfunction is associated with poor TB outcomes in New Zealand, which has high diabetes screening.AimTo characterise the population of TB-DM and TB-alone to assess the effect of diabetes status and renal function on hospitalisation and mortality.MethodsClinical records from all adult patients diagnosed with TB in Auckland over a 6-year period (2010-2015) were reviewed. Baseline demographics, clinical presentation and microbiological data were assessed to compare the rates of hospitalisation and mortality between those with TB-DM and TB-alone. Statistical significance was defined as P < 0.05.ResultsA total of 701 patients was identified with TB; 120 (17%) had an unknown diabetes status and were excluded, and 135 had co-existing diabetes. The TB-DM and TB-alone groups had similar distribution of TB site and proportions of Mycobacterium tuberculosis culture positivity. Univariate analysis showed TB-DM patients had statistically significantly higher proportions of acute hospitalisation and mortality. Multivariate logistic regression showed only a reduced estimated glomerular filtration rate (eGFR) accounted for the higher rates of hospitalisation, with the odds of hospitalisation increasing by 2% for every unit decrease in eGFR. The odds of mortality increased by 6% for every year increase in age, and the odds of mortality increased by 3% for every unit reduction in eGFR.ConclusionsDiabetes is associated with higher TB hospitalisation and mortality; however, this is likely mediated by increased age and chronic kidney disease.© 2021 Royal Australasian College of Physicians.

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