High Rates of Mortality During Drug-Resistant Tuberculosis Treatment Among Individuals With Diabetes Mellitus and Low Body Mass Index - Scorecard - MDSpire
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High Rates of Mortality During Drug-Resistant Tuberculosis Treatment Among Individuals With Diabetes Mellitus and Low Body Mass Index
Clinical Scorecard: Elevated Mortality Rates in Drug-Resistant Tuberculosis Treatment Among Diabetic Patients with Low Body Mass Index
At a Glance
Category
Detail
Condition
Rifampicin-resistant tuberculosis (RR-TB) with comorbid diabetes and low BMI
Key Mechanisms
Diabetes and low BMI independently and jointly increase mortality risk during RR-TB treatment, potentially via altered immunity, drug interactions, and treatment challenges
Target Population
Adults with RR-TB, particularly those with diabetes and BMI <18.5 kg/m2
Care Setting
Hospital and TB treatment centers managing drug-resistant TB in Indonesia and similar high-burden settings
Key Highlights
Diabetes doubles the risk of mortality during RR-TB treatment (adjusted hazard ratio ~2.05).
Low BMI (<18.5 kg/m2) independently increases mortality risk during RR-TB treatment (adjusted hazard ratio ~2.33).
The highest mortality risk occurs in patients with both diabetes and low BMI (adjusted hazard ratio ~7.14).
Guideline-Based Recommendations
Diagnosis
Screen all RR-TB patients for diabetes using HbA1c (≥6.5%) or prior clinical diagnosis at treatment initiation.
Assess nutritional status including BMI measurement at RR-TB treatment start.
Management
Provide integrated care addressing both RR-TB and diabetes to mitigate drug–drug interactions and adherence challenges.
Implement nutritional support and monitor weight gain during treatment to improve outcomes.
Monitoring & Follow-up
Closely monitor mortality risk in patients with combined diabetes and low BMI during RR-TB treatment.
Regularly assess glycemic control and nutritional status throughout RR-TB therapy.
Risks
Increased mortality risk associated with diabetes and low BMI during RR-TB treatment.
Potential for higher adverse drug reactions and treatment failure in patients with diabetes.
Patient & Prescribing Data
Adults with rifampicin-resistant tuberculosis, including those with diabetes and low BMI
Patients with diabetes and low BMI represent a high-risk subgroup requiring targeted interventions to reduce mortality during RR-TB treatment.
Clinical Best Practices
Early identification and management of diabetes in RR-TB patients.
Routine BMI assessment and nutritional interventions to address low BMI.
Integrated multidisciplinary care to manage complex comorbidities and improve adherence.
Use of HbA1c testing at treatment initiation for accurate diabetes diagnosis.
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
