Prevalence and clinical characteristics of Diabetes in Tuberculosis patients in Newham

Background. There is substantial evidence of the increasing burden of diabetes mellitus (DM) posing a threat to tuberculosis (TB) control globally. The global estimate of DM is expected to reach 592 million by 2030. In Europe, the estimated prevalence of DM is 8.5% and the rate of TB is 40 cases per 100,000 persons, with 74, 000 new cases per year (Badawi et al., 2014). It is estimated that DM triples the risk of developing TB when exposed an actively infected TB case, as well as modify the presenting features of TB, with more atypical radiological presentation, adverse TB treatment outcome, increased rates of relapse rates and death. The UK has the highest number of cases of TB in Western Europe. The London Borough of Newham has the highest number of cases in the UK, and this poses a public health risk. Thus, this research is aimed at analysing the prevalence of DM in TB patients in Newham and to describe the clinical presentation of Tuberculosis-Diabetes Mellitus (TB-DM) patients. Aim and objectives. The major objectives: 1. To determine the prevalence of DM in TB patients in Newham, with close attention paid to differences between UK-born and non-UK born patients; 2. To analyse the demographic, clinical characteristics and microbiological features associated with TB-DM compared with TB only patients. Methodology. The study was a retrospective cross-sectional survey on the prevalence of DM among diagnosed adult TB patients in Newham between the period of 2012-2015 with a follow-up period of 24 months from the London Borough of Newham, participants recruited from Barts Health NHS Trust. Results. Among the 489 TB patients used for this study, the prevalence of DM was 25.8 (range 24.3 – 33.0), greater than the UK average of 6.0%, and from the general population of Newham (3.9%) at the time of the study. The average patient age ranged from 27.5-49.9 years, with 85.3% of TB cases reported in the non-UK born population (P-value 0.087). Non-UK born individuals are more likely to be infected with TB, likely as a result of recent travel to high TB incidence areas or reactivation of latent TB, DM is not exclusively associated with the non-UK born population. DM was found to be significantly associated with age (P-value <0.005), comorbidities (P-value iv 0.007), worsening symptoms (night sweats (P-value 0.01), fever (P-value 0.02) and weight loss (P-value <0.001), social factors (heavy drinking (P-value 0.054) and person who injects drugs (P-value 0.04)). Microbiologically, the TB-DM cohort was likely to remain infectious for a longer period due to a higher bacterial load (P-value <0.001). Conclusion. In conclusion, DM poses a major challenge to controlling TB in Newham. A bi-directional screening of DM and TB cases, including screening of latent TB with DM, and tackling social determinants, i.e. the rise in the homeless population, use of illicit drugs and alcohol abuse, should be further evaluated to control the impact of TB cases.