Tuberculosis (TB) treatment challenges in TB-diabetes comorbid patients: a systematic review and meta-analysis

Abstract

Background

The Directly Observed Treatment-Short Course (DOTS) Programme was implemented by WHO and includes a combination of four anti-tuberculosis (TB) drugs (isoniazid, pyrazinamide, ethambutol and rifampicin) for a period of six months to eradicate the TB infection completely. Diabetes mellitus (DM) is recognized as one of a strong contributor of TB according to World Health Organization (WHO). The presence of diabetes mellitus type 2 (DM type 2) makes TB treatment complicated. Thus, the objective of the current meta-analysis was to identify and quantify the impact of type 2 DM on treatment outcomes of TB patients treated under the DOTS Programme.

Methods

This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Through a systematic review of relevant literature, we focused on studies investigating treatment outcomes including extended treatment duration and recurrence for individuals with both TB and DM undergoing DOTS therapy. The extracted information included study designs, sample sizes, patient characteristics and reported treatment results.

Results

In 44 studies from different parts of the world, the pooled HR for the impact of DM on extended treatment duration and reoccurrence were HR 0.72, 95% CI 0.56–0.83, p < .01 and HR 0.93, 95% CI 0.70–1.04, p = .08, respectively. The pooled HR for impact of DM on composite TB treatment outcomes was calculated as 0.76 (95% CI 0.60–0.87), p < .01 with an effect size of 41.18. The heterogeneity observed among the included studies was moderate (I² = 55.79%).

Conclusions

A negative impact of DM was found on recurrence and extended treatment duration in TB patients treated with DOTS therapy. DM type 2 is responsible for the TB treatment prolongation and TB recurrence rates. By implementing effective management strategies and advancing research, the challenges can be mitigated, arising due to the complex interaction between DM and TB.

Keywords:

• Diabetes mellitus
• tuberculosis
• comorbidity
• extended treatment duration
• recurrence
• disease progression

Author contributions

M.K., A.R. and T.M.; methodology, M.K., A.R. and M.S.A., software, R.H. and Z.S.; validation, M.F.R., S.A.A. and M.S.A.; formal analysis, A.R., M.K. and A.H.; resources, A.R. and A.H.; data curation, M.K., S.Z.F. and M.F.N.; writing-original draft preparation, M.K., A.R., A.H. and M.S.A.; writing-review and editing, O.M.A., A.A.B., S.A.A. and H.M.A., Z.S.; supervision, A.R. All authors have read and agreed to the published version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data are available on request from the corresponding author.

Additional information

Funding

No funding was received.