90 Chapter 4 Summary Background: The increasing burden of diabetes mellitus in low- and middle-income countries (LMICs) negatively impacts current tuberculosis control efforts. To understand this dual burden in Eswatini, we describe the prevalence and predictors of elevated baseline blood glucose and unfavourable tuberculosis treatment outcomes. Methods: We used a prospective cohort study design at 11 purposively selected health facilities in Eswatini. Adults ≥18 years commencing tuberculosis treatment were recruited into the study and followed up until the end of treatment. Blood glucose measurements were taken at baseline and in months 2 and 5. Patients sociodemographic and clinical data were extracted from treatment cards and registers. We computed the prevalence of elevated blood glucose (random≥11.1mmol/l or fasting>5.5mmol/l) and used logistic regression to determine the predictors of elevated baseline blood glucose and unfavourable treatment outcomes. Findings: We consecutively enrolled 369 patients. The mean age was 38.4 (SD: 12.9) years and 202 (54.7%) were males. The median baseline blood glucose was 5.5mmol/l (IQR 4.8, 6.7), reducing to 5.3mmol/l (IQR 4.8, 6.2) (p=0.0413) and 5.2mmol/l (IQR 4.8, 5.9) (p=0.0002) at months 2 and 5 respectively. The prevalence of elevated baseline blood glucose was 8.0% (95% CI: 5.5, 11.3); 8.9% in males (95%CI: 5.6, 13.9); increased with age, highest at ≥55 years (13.6%; 95% CI: 6.2, 27.3); and more elevated in reactive HIV patients at 9.5% (95% CI: 6.5, 13.7). A family history of diabetes mellitus (Adjusted Odds Ratio (AOR) 2.80; 95%CI: 1.08, 7.32) and a reactive HIV status (AOR 4.62; 95%CI: 1.06, 20.11) significantly predicted elevated baseline blood glucose. Three-quarters (n=276, 75.4%) had a favourable tuberculosis treatment outcome; more males (N=59, 66%) had an unfavourable treatment outcome (p=0.020), the most common unfavourable outcome being death (n=34, 9.2%). Hypertension (AOR 4.84; 95% CI: 1.48, 15.7), unemployment (AOR 2.01; 95%CI: 1.08, 3.71) and high school education (AOR 0.32; 95%CI: 0.16, 0.64), but not blood glucose, were associated with unfavourable treatment outcome. Interpretation: Our study shows the need to optimise care for patients receiving treatment for tuberculosis by integrating screening for and treatment of diabetes and hypertension, prioritising males, those aged ≥55 years and those with a reactive HIV status to limit unfavourable outcomes and death. Funding: This study was funded by the Global Health PhD Support Programme at the University Medical Center, Utrecht, The Netherlands.
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