P-1382. Stress hyperglycemia during tuberculosis treatment and rate of sputum culture conversion

TL;DR

Stress hyperglycemia during TB treatment is linked to slower sputum culture conversion compared to normal blood sugar levels.

Contribution

This study is the first to investigate the impact of stress hyperglycemia on TB treatment outcomes in a prospective cohort.

Findings

Stress hyperglycemia at treatment start was associated with lower culture conversion rates (82%) compared to euglycemic participants (96%).

Participants with stress hyperglycemia showed a trend toward slower time to culture conversion compared to euglycemic individuals.

Abstract

Tuberculosis (TB) is the leading cause of infectious disease mortality worldwide. Diabetes increases the risk of poor TB treatment outcomes and is increasingly prevalent in high-TB burden settings. However, whether TB-induced stress hyperglycemia impacts TB treatment outcomes is unclear. We compared TB culture conversion rates among stress hyperglycemic participants to those with diabetes/pre-diabetes or euglycemia.

This is an on-going prospective cohort study of adults with newly-diagnosed pulmonary TB disease in the country of Georgia. At treatment initiation, participants were categorized as having diabetes (DM)/prediabetes (pre-DM), euglycemia, or stress hyperglycemia (defined as hemoglobin A1c [HbA1c] ≥ 5.7% or fasting blood glucose [FBG] ≥ 100 mg/dl at TB treatment start and HbA1c < 5.7% or FBG < 100 mg/dl within 2 months). Culture conversion was defined as two consecutive monthly negative Mtb cultures with no subsequent positive cultures. Culture conversion rates were compared by glycemic status using Kaplan Meier curves and hazards regression.

Among 225 participants (64% of target enrollment) with culture data available to date: median age was 40 years (IQR 29-54), median BMI was 20.7 kg/m2 (IQR 18.6-23.8), and 38% were female. At enrollment, 43% had stress hyperglycemia, 17% had DM or pre-DM, and 40% had euglycemia. Overall, 200 participants (89%) achieved culture conversion by 2 months, with the lowest proportion of culture conversion in the stress hyperglycemia group (82% converted, vs 89% DM/pre-DM and 96% euglycemic; p=0.01). Median time to culture conversion was 58 days (IQR 30-62) among participants with stress hyperglycemia, compared to 59 days (IQR 31-72) among DM/pre-DM and 51 days (IQR 30-62) among euglycemic participants (Figure 1; p=0.10). After adjusting for age, sex, and baseline BMI, participants with stress hyperglycemia (HR 0.75, 95%CI 0.5-1.0) and DM/pre-DM (HR 0.72, 95%CI 0.5-1.1) had reduced culture conversion rates compared to euglycemic participants.

In preliminary analysis, we found >40% of participants had stress hyperglycemia at TB treatment initiation. Participants with stress hyperglycemia trended to have reduced culture conversion rates compared to those with euglycemia.

Francisco J. Pasquel, MD, MPH, Dexcom: Grant/Research Support|Dexcom: Grant/Research Support|Dexcom: Honoraria|Ideal Medical Technologies: Grant/Research Support|Insulet: Grant/Research Support|Novo Nordisk: Grant/Research Support|Tandem Diabetes Care: Grant/Research Support