Influence of Type 2 Diabetes Mellitus on the Clinical Outcomes in Hospitalized Patients with Active Pulmonary Tuberculosis: A Retrospective, Single-Center, Real-World Study in China

Cuilin Shi,* Xinghua Shen,* Jing Liu,* Lijun Huang,* Huanglei Ni, Peijun Tang, Yanjun Feng, Meiying Wu, Jianping Zhang The Affiliated Infectious Diseases Hospital of Soochow University, The Fifth People’s Hospital of Suzhou, Suzhou, 215000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Meiying Wu, The Affiliated Infectious Diseases Hospital of Soochow University, The Fifth People’s Hospital of Suzhou, 10 Guangqian Road, Xiangcheng District, Suzhou, 215000, People’s Republic of China, Tel + 86-512-87806067, Email [email protected] Jianping Zhang, The Affiliated Infectious Diseases Hospital of Soochow University, The Fifth People’s Hospital of Suzhou, 10 Guangqian Road, Xiangcheng District, Suzhou, 215000, People’s Republic of China, Email [email protected]: To explore the influence of type 2 diabetes mellitus (T2DM) on the clinical outcomes of pulmonary tuberculosis (TB) and the factors that may affect outcomes. In addition, the treatment regimens of active pulmonary TB patients with or without T2DM were described.Methods: This is a retrospective, single-center, real-world study conducted in the Fifth People’s Hospital of Suzhou (China), an urban hospital. This study divided 340 inpatients with active TB who received standard anti-tuberculosis treatment into the T2DM and control groups, with 61 patients in the T2DM group and 279 patients in the control group. The outcomes were the time to negative Mycobacterium tuberculosis sputum conversion and the rate of negative sputum conversion for tuberculosis bacteria at 2 months.Results: The percentage of patients who received the isoniazid, rifampin, pyrazinamide, and ethambutol (HRZE) regimen was numerically lower in the T2DM vs control group (73.8% vs 79.6%), while the use of the isoniazid, rifapentine, ethambutol, and levofloxacin (HRftELfx) regimen was numerically higher (14.8% vs 9.7%). The median time to negative sputum conversion was longer in the T2DM group (median, 60.00 vs 52.00 days, P< 0.001). The rates of negative sputum conversion at 2 months were 85.2% vs 92.8% in the T2DM and control groups (P=0.055). The multivariable Cox regression analysis showed that the male sex (adjusted HR=0.759, 95% CI: 0.585– 0.984, P=0.037) and T2DM (adjusted HR=0.721, 95% CI: 0.528– 0.986, P=0.040) were independently associated with the time to negative sputum Mycobacterium tuberculosis conversion.Conclusion: Patients with TB and T2DM had a longer time to negative sputum Mycobacterium tuberculosis conversion. In addition, being male significantly increased the risk of prolonged time to negative sputum Mycobacterium tuberculosis conversion.Keywords: tuberculosis, type 2 diabetes mellitus, anti-tuberculosis drugs, treatment regimens, prognosis