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The relationship between HbA1c control levels and anti-tuberculosis treatment effects: A meta-analysis.

BACKGROUND
Multiple studies of tuberculosis treatment have indicated that patients with diabetes mellitus (DM) may experience poor outcomes. We performed a meta-analysis to summarize evidence for the relationship between HbA1c control levels and anti-tuberculosis treatment effects in patients afflicted with both tuberculosis and DM.


METHODS
Both English and Chinese databases were searched. Chinese databases included CNKI, WanFang, SinoMed, and VIP. PubMed, Ovid MEDLINE, Embase, Cochrane Library, and Web of Science were searched for English articles. We included studies that were restricted to the relationship between HbA1c levels and anti-tuberculosis treatment effects [sputum conversion rate (SCR) and tuberculosis focus absorption] in diabetic patients receiving treatment for tuberculosis. We used RevMan 5.3 software to analyze the data.


RESULTS
We included twelve studies of which five reported SCR at two months, seven reported the conversion at three months, and seven reported tuberculosis focus absorption. According to the five studies which reported two months-SCR, patients with diabetes and tuberculosis had an odds ratio (OR) of 2.14 (95% CI: 0.84-5.43) for the two months-SCR between controlled (HbA1c <7.0) and uncontrolled diabetes (HbA1c ≥7.0). However, an additional seven studies reporting three months-SCR showed that controlled diabetics had higher SCR than uncontrolled (OR 3.39, 95% CI: 2.12-5.43). Moreover, seven of the twelve studies demonstrated that there were differences in tuberculosis focus absorption between controlled and uncontrolled diabetes (OR 2.69, 95% CI: 1.91-3.79).


CONCLUSION
HbA1c control levels influence the SCR at three months and the tuberculosis focus absorption at the end of the anti-tuberculosis intensive treatment phase. This study highlights a need for increased attention to HbA1c or glucose control in patients afflicted with both TB and DM.