27 2 Tuberculosis treatment and abnormal blood glucose. varied, all aimed at studying or identifying IGT or hyperglycaemia during TB treatment. The studies were all observational, and 50% (n=7) were prospective cohort studies. Twenty-one per cent (n=3) were case-control studies, and 14% (n=2) were a combination of cross-sectional and prospective cohort studies. The sample size for the studies varied from 21 to 6,312, and participants from ten studies were patients receiving treatment for drug-sensitive TB. Of the remaining four studies, each used either multidrug-resistant TB patients (MDR-TB), HIV-TB co-infected patients, patients attending a private clinic or patients with respiratory symptoms. The participants were mostly males, with the proportion of males ranging from 49% to 78%, and the mean age of all participants ranged from 29.5 to 53 years. Seven out of the 14 studies (50%) included HIV-co-infected participants. The proportion of HIV co-infection in four studies was less than 10%, then 26%, 61% and 100% in the remaining three studies. In ten studies, participants received first-line TB treatment, one was a second-line only and three were all types of treatment. Method of glucose estimation Four main types of glucose estimation tests were used either singly or in combination. These include FBS (64%), glycated haemoglobin test (HbA1c) (50%), oral glucose tolerance test (OGTT) (50%) and random blood sugar test (RBS) (14%). Some studies combined two or more tests to estimate glucose levels: 36% (FBS + OGTT), 21% (FBS + HbA1c), 14% (HbA1c + OGTT), 14% (RBS + HbA1c), 7% (FBS + HbA1c + OGTT) and 7% (RBS + HbA1c + OGTT). Time of glucose estimation Five described the time of glucose estimation in the studies: baseline, three months, six months, end of treatment and post-treatment (Figure 2, Table 2). Measurements were done at baseline in all 14 studies and a combination of time points thereafter. Two studies (14%) used all five parameters to describe the time of glucose estimation. Glucose changes during tuberculosis treatment Most of the studies defined DM and hyperglycaemia based on the guidance provided by the American Diabetes Association [37]. In this guide, DM is defined as glucose level ≥7.0 mmol/l, ≥11.1 mmol/l or ≥6.5% using FBS, OGTT or HbA1c, respectively. IGT is similarly defined as a glucose level of 5.6 to 6.9 mmol/l, 7.8 to 11.0 mmol/l or 5.7 to 6.4% using FBS, OGTT or HbA1c, respectively. The studies excluded patients with a known diagnosis of DM before conducting a baseline glucose test. With some variability, patients identified with glucose levels consistent with DM and hyperglycaemia had repeat tests at specified periods. Table 2 describes the proportion of participants with DM and hyperglycaemia at baseline and during the follow-up period.
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