BACKGROUND AND SIGNIFICANCE: One effective tuberculosis (TB) case-holding strategy currently being implemented by the Department of Health to improve compliance is the Directly Observed Treatment Strategy (DOTS) wherein health workers watch as each patient takes the correct anti-TB medications during the course of therapy. The DOTS at the University of Santo Tomas Hospital was started last September 1995. Since then, it has already catered to about 300 patients. With the emergence of TB and diabetes mellitus (DM) as possible co-epidemics in the Philippines, aggressive treatment of TB with concomitant control of DM is a must. In keeping with the advances in TB control and changes in diabetes mellitus diagnosis and management, we embarked on this study to review the presentation and treatment outcome of TB in diabetics under DOTS at our institution.
AIM: This study aims to describe the profile and treatment outcome of diabetics with tuberculosis under the Directly Observed Treatment Strategy (DOTS) of the University of Santo Tomas Hospital (USTH) and compare the findings with their non-diabetic counterparts.
STUDY DESIGN: Descriptive retrospective cross-sectional study
METHODOLOGY: A review of the medical records of diabetics with tuberculosis enrolled at the USTH-DOTS was done. All diabetics with tuberculosis were defined based on demographic data, clinical, radiologic and microbiologic profile. Results were then compared with their nondiabetic counterparts.
RESULTS: Among the 299 enrollees, twenty-four (24) had diabetes mellitus (8 percent of the enrollees). Sixteen (16) were known diabetics prior to TB diagnosis, while 8 were found to be diabetic on work-up during the course of therapy. Ages ranged from 31 to 71 (mean 50.6 years). There were 13 females and 11 males with a ratio of 1.2:1. Cough, fever, weight loss and anorexia were the most common presenting features in both groups. Fifty-four percent (54 percent) of diabetics had previous intake of anti-16 drugs in contrast to 13.8 percent of nondiabetics. Fifty eight percent (58 percent) of diabetics vs 34.18 percent of nondiabetics had positive AFB smear, 29.16 percent of diabetics vs 21.45 percent of nondiabetics had positive sputum MTB culture. 16.7 percent of diabetics vs 12.7 percent of nondiabetics had in-vitro first line drug resistance. 12.5 percent of diabetics vs 4 percent of nondiabetics had in-vitro multidrug-resistant tuberculosis. 12.5 percent of diabetics vs 3.27 percent of nondiabetics had in-vitro resistance to ciprofloxacin. 50 percent of diabetics and 29.45 percent of nondiabetics had cavities on chest xray. Moderately-advanced lesions on chest xray were the usual presentation in both groups. Fifty percent (50 percent) of diabetics vs 60 percent of nondiabetics had purely apical involvement, while 37.5 percent of diabetics vs 19.6 percent of nondiabetics presented with multilobar lesions. One out of the 24 diabetics presented solely with middle lobe involvement. Completion rate for diabetics was at 87.5 percent, while nondiabetics had 82.9 percent completion rate.
CONCLUSION: Though this study was limited by its small number of subjects and by its retrospective data collection, there were differences in disease patterns of tuberculosis, though not statistically significant, in diabetics as compared to nondiabetics like the relatively higher multi-drug resistance, ciprofloxacin resistance and treatment failure rates.