28 Chapter 2 Twelve (86%) studies showed the proportion of previously normoglycaemic patients with glucose values in the DM and IGT range at baseline reduced during treatment follow-up and end of treatment, while only two studies [15, 35] showed an increase (Table 2). DM decreased from 11.9% at baseline to 9.3% at follow-up, while IGT decreased from 46.9% at baseline to 21.5% at follow-up [36] in one of the studies conducted in South Africa. On the contrary, an Iranian cohort study [15] showed that 24% of patients developed DM in the follow-up period, while the proportion with IGT increased from 31% to 34%. Similarly, another study in Pakistan [35] observed that the proportion of IGT increased from 32% at baseline to 42% at follow-up. Most of the follow-up was done at three months (71%) followed by end of treatment (43%). With follow-up at different times, most studies (86%) agree there is a reduction in the glucose level at follow-up compared to baseline and dysglycaemia observed at baseline normalised at follow-up or end of treatment. Glucose levels were higher in older patients, mostly above 40 years, compared to younger patients [13-15]. TB treatment outcome and glucose changes A summary of results with TB treatment outcomes and glucose changes is presented in Table 3. In three studies, 64%, 75% and 95% of the patients had a successful treatment outcome [15, 33, 34]. Two studies indicated that TB patients with DM or IGT were more likely to develop cavitary lung lesions, with one of the studies indicating a 54% prevalence [15, 30]. In one study where patients were followed up to one year after TB treatment, patients with hyperglycaemia had a 48.9% risk of mortality compared to 7.9% in those with euglycaemia [33]. While another study showed that hyperglycaemia at enrolment diagnosed using fasting capillary glucose was associated with poor treatment outcomes such as loss to follow-up, treatment failure or death (aOR 2.46; 95% CI: 1.08 to 5.57) [21], a 2019 study from Mali [34] indicates that blood sugar levels had no impact on TB treatment outcomes. Researchers in Nigeria [31] did not find any difference in HbA1c levels based on HIV status, but a 2017 study in China [32] showed an HIV positive status, DM, smoking cigarettes and presenting to a hospital instead of a clinic were associated with an unstable FBS during TB treatment. Outcomes in TB-HIV co-infected patients Of the seven studies that included HIV co-infected participants, six provided information on glucose changes or their association with TB treatment outcomes based on the HIV status of the participants. The different outcomes are presented in Table 4.
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