High Rates of Mortality During Drug-Resistant Tuberculosis Treatment Among Individuals With Diabetes Mellitus and Low Body Mass Index - Report - MDSpire
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High Rates of Mortality During Drug-Resistant Tuberculosis Treatment Among Individuals With Diabetes Mellitus and Low Body Mass Index
Elevated Mortality in Drug-Resistant TB Treatment Among Diabetic Patients with Low BMI
Overview
This study found that diabetes doubles the risk of mortality during rifampicin-resistant tuberculosis (RR-TB) treatment. The highest mortality rates were observed in patients with both diabetes and low body mass index (BMI <18.5 kg/m2).
Background
Rifampicin-resistant tuberculosis (RR-TB) poses significant treatment challenges due to longer, more toxic regimens and higher mortality risks. Diabetes is a known risk factor for poor outcomes in RR-TB, but its interaction with nutritional status, particularly low BMI, has been unclear. Low BMI is common in TB patients and associated with increased mortality. Understanding how diabetes and low BMI jointly affect RR-TB treatment outcomes is critical, especially in high-burden countries like Indonesia.
Data Highlights
Characteristic
Value
Sample size
345 adults with RR-TB
Male
57%
HIV positive
1.7%
BMI <18.5 kg/m2
59%
Diabetes prevalence
28% (96 individuals)
Mortality during treatment
18% (62 individuals)
Adjusted hazard ratio (aHR) for mortality with diabetes
2.05 (95% CI, 1.17–3.58)
aHR for mortality with BMI <18.5 kg/m2
2.33 (95% CI, 1.28–4.21)
aHR for mortality with diabetes and BMI <18.5 kg/m2
7.14 (95% CI, 2.71–18.82)
Key Findings
Diabetes independently doubles the risk of mortality during RR-TB treatment (aHR 2.05).
No significant multiplicative or additive interaction was detected between diabetes and low BMI.
Patients with both diabetes and low BMI have the highest mortality risk (aHR 7.14) compared to those without diabetes and normal BMI.
Among 345 RR-TB patients, 28% had diabetes and 59% had low BMI, highlighting the high prevalence of these risk factors.
Clinical Implications
Clinicians should recognize diabetes and low BMI as key risk factors for mortality in RR-TB treatment. Screening for diabetes and nutritional status at treatment initiation can identify high-risk patients who may benefit from intensified monitoring and tailored interventions. Addressing both glycemic control and nutritional support may improve treatment outcomes in this vulnerable population.
Conclusion
Diabetes significantly increases mortality risk during RR-TB treatment, especially when combined with low BMI. Targeted strategies addressing both diabetes management and nutritional status are essential to reduce mortality in RR-TB patients.
by Lara D Veeken, Iceu D Kulsum, Bony W Lestari, Prayudi Santoso, Nanny N M Soetedjo, Raspati C Koesoemadinata, Adriana V Miranda, Wini Sukmawati, Argita D Salindri, Arto Y Soeroto, Reinout van Crevel
