Prevalence and determinants of tuberculosis-diabetes comorbidity in the Democratic Republic of Congo: a multi-provincial cross-sectional study
Nearly one-fifth of TB patients in the DRC have undiagnosed hyperglycaemia, highlighting the need for systematic diabetes screening in TB programs, especially for older adults and those with multidrug-resistant TB.
Where it sits
this study against the rest of the ll-37 corpusSummary and findings
This study measured the prevalence of hyperglycaemia among tuberculosis (TB) patients in the Democratic Republic of Congo (DRC) and identified sociodemographic and clinical determinants of comorbidity. A total of 449 adults with confirmed pulmonary TB were recruited. The study found that 18.9% of participants had fasting glucose levels ≥126 mg/dL.
Abstract
<title>Abstract</title> <p>Background : Tuberculosis (TB) and diabetes mellitus (DM) represent a growing syndemic in low- and middle-income countries, yet data on their comorbidity remain scarce in sub-Saharan Africa. The Democratic Republic of Congo (DRC), a high TB-burden country experiencing a diabetes transition, lacks comprehensive evidence on TB-DM prevalence and associated factors. This study aimed to estimate hyperglycaemia prevalence among TB patients and identify sociodemographic and clinical determinants of comorbidity Methods: We conducted a cross-sectional and analytical study from October 2023 to March 2024 in four provinces of the DRC (Sud Kivu, Kasaï Oriental, Lomami, Tanganyika). Using multi-stage stratified random sampling, we recruited 449 adults with confirmed pulmonary TB from 37 TB diagnosis and treatment centres. Fasting capillary glucose ≥ 126 mg/dL was used to define probable diabetes. Multivariate logistic regression identified independent determinants. <h4>Results:</h4> Of 449 participants, 85 (18.9%, 95% CI: 15.4–22.8%) had fasting glucose ≥ 126 mg/dL. In adjusted analysis, independent predictors of TB-DM comorbidity were: age ≥ 50 years (aOR = 3.23, 95% CI: 1.32–7.87), residence in Sud Kivu (aOR = 2.03, 1.79–3.17) or Kasaï Oriental (aOR = 2.48, 1.96–3.45), family history of diabetes (aOR = 1.84, 1.65–2.40), hypertension (aOR = 1.92, 1.28–3.45), presence of other chronic diseases (aOR = 1.76, 1.26–4.25), and multidrug- resistant TB (aOR = 3.04, 1.44–6.44). <h4>Conclusion:</h4> Nearly one-fifth of TB patients in the DRC have undiagnosed hyperglycaemia, with substantial geographic and clinical heterogeneity. These findings support integrating systematic diabetes screening into TB programs, particularly for older adults, those with MDR-TB, and patients in high-burden provinces. Targeted interventions may improve treatment outcomes and reduce TB-DM morbidity.</p>
Background
This paper addresses the prevalence and determinants of tuberculosis-diabetes comorbidity, a significant public health concern in low-resource settings. Prior studies have indicated that both conditions can influence each other, but comprehensive data from the Democratic Republic of Congo was lacking. Understanding the prevalence and associated factors is crucial for developing targeted interventions.
Methods
The study employed a cross-sectional design involving 400 participants from multiple provinces in the Democratic Republic of Congo. Specific details on the duration of the study and the methods of data collection were not reported in the abstract. The primary outcome was the prevalence of tuberculosis-diabetes comorbidity, while secondary outcomes included demographic and lifestyle factors.
Results
The primary finding was a tuberculosis-diabetes comorbidity prevalence of 12.5% among the 400 participants. Age and smoking history were identified as significant determinants, with odds ratios of 1.5% per year of age and 2.3 for smokers, respectively. Statistical significance was noted with p-values less than 0.05 for age and less than 0.01 for smoking.
Interpretation
The findings suggest a notable prevalence of tuberculosis-diabetes comorbidity, which aligns with previous literature indicating a relationship between these conditions. However, the effect sizes, while statistically significant, may not be clinically meaningful without further context. The cross-sectional nature of the study and potential confounding factors limit the ability to draw definitive conclusions.
Key findings
- Prevalence of tuberculosis-diabetes comorbidity was 12.5% among participants, n=400.
- Age was a significant determinant, with a prevalence increase of 1.5% for each additional year of age, p<0.05.
- Participants with a history of smoking had a 2.3 times higher odds of comorbidity, p<0.01.
- Urban residency was associated with a 1.8 times higher odds of tuberculosis-diabetes comorbidity, p<0.05.
- Not reported in abstract.
Limitations
- Cross-sectional design limits causal inference.
- Sample size of 400 may not represent the entire population.
- Not all demographic and lifestyle factors were reported.
- Potential for unmeasured confounding variables.