Time To Develop Tuberculosis And Its Predictors Among Adult Diabetes Mellitus Patients On Follow-Up At Chronic Outpatient Department Of Hospitals In Southwest Shoa Zone, Oromia, 2023

Abstract

Background: Tuberculosis is an emerging public health problem among diabetic patients. Diabetes, which causes immune suppression, is highly recognized as an independent risk factor for tuberculosis and the two often coexist and influence each other. Developing countries are suffering from chronic diseases in which DM is the leading one that further exposes individuals to suffer from TB. Objective: The main aim of the study was to identify the time to develop TB and its predictors among adult DM patients on follow-up at hospitals of Southwest Shoa, Oromia, 2023 Methods: Facility based retrospective cohort study was conducted among 346 diabetic patients on follow-up from 2013-2022. The study samples were selected by systematic random sampling and a questionnaire and data extraction checklist were used for data collection. A data was collected by trained nurses through patients interview and reviewing their history cards from December 17, 2022 to March 06, 2023. Variables with P-value <0.25 at bi-variable Cox regression analysis were entered into multivariable Cox model. The proportional hazard assumption was checked for each variable and no variable was found with Schoenfeld residual test <0.05. A Multivariable Cox regression model with 95%CI and AHR was used to identify significant predictor variables to develop TB at P< 0.05 Result: Three hundred thirty one patients with a response rate of 95.7% have followed for 1759.32 Person Years of observation (PYO). The overall incidence density of tuberculosis in diabetic patients was 2.2/ 100 PYOs. The minimum and maximum follow-up time was 2.01 and 9.15 years, respectively. The median age of the patients on diabetic care was 50 years (IQR=23). Being age >50 years, being Type I DM, smoking history, history of previous TB treatment were highly significant predictors. Being HIV positive, being an alcohol user, and forgetting to take medication were also other moderate risks for tuberculosis among DM patients. Conclusion and Recommendation: More than 55% of TB incidences occurred within five years of follow-up after diabetic care started. Older age and type I DM were the most predictors of TB in diabetic patients. So intensified screening and follow up is highly recommended for all diabetic patients.