Abstract:

It is well documented in the literature that there is poor treatment outcome in patients with Tuberculosis and Diabetes (TBDM) comorbidity due to the observed interference of drugs for Tuberculosis (TB) treatment on anti-diabetic drugs and elevated glucose level reduces the efficacy of anti- tuberculosis drugs leading to poor TB treatment outcome, and that insulin therapy is not affected by this drug interaction. Importantly, access to Insulin is a challenge due to its prohibitive out-of-pocket cost. The only alternative sustainable treatment for TBDM patients in resource-limited communities is lifestyle-based intervention. This study evaluated the impact of lifestyle intervention on TB treatment outcomes in patients with TBDM comorbidity. This study is a quasi-experimental intervention involving two cohorts of 25 TBDM patients each, as control and experimental cohorts. Their enrolment was from Tuberculosis patients from health facilities in Lagos and Oyo states. The questionnaires were administered before the commencement of the Intervention and at 8 weeks. The sputum Acid Fast Bacillus (AFB) was checked, and chest x-ray (CXR) done before Intervention and Sputum AFB at 8 weeks. The Control group showed no difference in the means of the sputum AFB 95%CI: 0.12(- 0.12 – 0.36; p>0.05), which was an indication of poor treatment outcome. The difference in the means of the sputum AFB in the intervention group was statistically significant 95%CI: -0.8(-0.9 - -0.6; p<0.05). The intervention with educational and behavioral lifestyle modifications significantly improved the outcome of treatment of TB in TBDM comorbidity.

References:

[1] World Health Organization. (2020). Tuberculosis. https://www.who.int/news-room/fact- sheets/detail/tuberculosis. Assessed 15/04/21.

[2] Afroz, A., Alramadan, M. J., Hossain, M. N., Romero, L., Alam, K., Magliano, D. J., & Billah, B. (2018). Cost-of-illness of type 2 diabetes mellitus in low and lower-middle-income countries: a systematic review. BMC health services research, 18(1), 972. https://doi.org/10.1186/s12913-018-3772-8.

[3] Lin, X., Xu, Y., Pan, X. et al. (2020). Global, regional, and national burden and trend of Diabetes in 195 countries and territories: an analysis from 1990 to 2025. SciRep 10, 14790. https://doi.org/10.1038/s41598-020-71908-9.

[4] Dunachie, S., & Chamnan, P. (2019). The double burden of Diabetes and global infection in low and middle-income countries. Transactions of the Royal Society of Tropical Medicine and Hygiene, 113(2), 56–64. https://doi.org/10.1093/trstmh/try124.

[5] Saklayen M. G. (2018). The Global Epidemic of the Metabolic Syndrome. Current hypertension reports, 20(2), 12. https://doi.org/10.1007/s11906-018-0812-z.

[6] York E, Atiase Y, et al. (2017). The Bidirectional Relationship between Tuberculosis and Diabetes. Tuberculosis Research and Treatment.1702578. https://doi.org/10.1155/2017/1702578. Assessed 16/04/21.

[7] Silva, D. R., Muñoz-Torrico, M., Duarte, R., Galvão, T., Bonini, E. H., Arbex, F. F., Arbex, M. A., Augusto, V. M., Rabahi, M. F., & Mello, F. (2018). Risk factors for tuberculosis: diabetes, smoking, alcohol use, and the use of other drugs. Jornal brasileiro de pneumologia: publicacao oficial da Sociedade Brasileira de Pneumologia e Tisilogia, 44(2), 145–152. https://doi.org/10.1590/s1806-37562017000000443.

[8] Sahakyan, S., Petrosyan, V., & Abrahamyan, L. (2020). Diabetes mellitus and treatment outcomes of pulmonary Tuberculosis: a cohort study. International journal of public health, 65(1), 37–43. https://doi.org/10.1007/s00038-019-01277-2.

[9] Ayelign, B., Negash, M., Genetu, M., Wondmagegn, T., & Shibabaw, T. (2019). Immunological Impacts of Diabetes on the Susceptibility of Mycobacterium tuberculosis. Journal of immunology research, 2019, 6196532. https://doi.org/10.1155/2019/6196532.

[10] Mahishale, V., Avuthu, S., Patil, B., Lolly, M., Eti, A., & Khan, S. (2017). Effect of Poor Glycemic Control in Newly Diagnosed Patients with Smear-Positive Pulmonary Tuberculosis and Type-2 Diabetes Mellitus. Iranian journal of medical sciences, 42(2), 144–151. Available at http://www.ncbi.nlm.nih.gov>articles>PMC5366362. Accessed 22/05/21.

[11] Alawode, G.O., Adewole, D.A. (2021). Assessment of the design and implementation challenges of the National Health Insurance Scheme in Nigeria: a qualitative study among sub- national level actors, healthcare, and insurance providers. BMC Public Health 21,124. https://doi.org/10.1186/s12889-020-10133-5. Accessed 23/04/2021.

[12] Wenzel, I. C.., Silva, K. A.., Furino, V. de O.., Duarte, F. O.., Castro, C. A. de, & Duarte, A. C. G. O. (2022). Impact of Postural Corrective Training (TCP®) on overall glycemic control in diabetic middle-aged women. Research, Society and Development, 11(14), e194111435600. https://doi.org/10.33448/rsd-v11i14.35600).

[13] Kirwan, J. P., Sacks, J., & Nieuwoudt, S. (2017). The essential role of exercise in the management of type 2 diabetes. Cleveland Clinic journal of medicine, 84(7 Suppl 1), S15–S21. https://doi.org/10.3949/ccjm.84.s1.03.

[14] Yang D, Yang Y, Li Y, Han R. (2019). Physical Exercise as Therapy for Type 2 Diabetes Mellitus: From Mechanism to Orientation. Ann Nutr Metab. 74:313–321. DOI: 10.1159/000500110.

[15] Katula, J. A., Kirk, J. K., Pedley, C. F., Savoca, M. R., Effoe, V. S., Bell, R. A., Bertoni, A. G., & LIFT Diabetes Team (2017). The Lifestyle Intervention for the Treatment of Diabetes study (LIFT Diabetes): Design and baseline characteristics for a randomized translational trial to improve control of cardiovascular disease risk factors. Contemporary clinical trials, 53, 89–99. https://doi.org/10.1016/j.cct.2016.12.005.

[16] Alessandra Celli, Yoann Barnouin, Bryan Jiang, Dean Blevins, Georgia Colleluori, Sanjay Mediwala, Reina Armamento-Villareal, Clifford Qualls, Dennis T. Villareal. (2022). Lifestyle Intervention Strategy to Treat Diabetes in Older Adults: A Randomized Controlled Trial. Diabetes Care. 45 (9), 1943–1952. https://doi.org/10.2337/dc22-0338.

[17] Middelbeek, R.J.W., Hafida, S., Schrager, C. (2022). Medical Nutrition Therapy for the Treatment of Diabetes: Prioritizing Recommendations Based on Evidence. In: Wilson, T., Temple, N.J., Bray, G.A. (eds) Nutrition Guide for Physicians and Related Healthcare Professions. Nutrition and Health. Humana, Cham. https://doi.org/10.1007/978-3-030-82515-7_10.

[18] Sami, W., Ansari, T., Butt, N. S., & Hamid, M. R. A. (2017). Effect of diet on type 2 diabetes mellitus: A review. International journal of health sciences, 11(2), 65–71.

[19] Yoshino, M., Kayser, B. D., Yoshino, J., Stein, R. I., Reeds, D., Eagon, J. C., ... & Klein, S. (2020). Effects of diet versus gastric bypass on metabolic function in diabetes. New England Journal of Medicine, 383(8), 721-732.

[20] World Health Organization. (2018). Latent TB Infection: Updated and consolidated guidelines for programmatic management. https://www.who.int/tb/publications/2018/latent-tuberculosis- infection/en/. Assessed 19/04/21.

[21] Asemahagn, M.A. (2021). Sputum smear conversion and associated factors among smear-positive pulmonary tuberculosis patients in East Gojjam Zone, Northwest Ethiopia: a longitudinal study. BMC Pulm Med 21, 118. https://doi.org/10.1186/s12890-021-01483-w.

[22] Centers for Disease Control and Prevention (.gov). › eat-well › meal-plan-method. https://www.cdc.gov.

[23] Wolff, K., Cavanaugh, K., Malone, R., et al. (2009). The Diabetes Literacy and Numeracy Education Toolkit (DLNET): materials to facilitate diabetes education and management in patients with low literacy and numeracy skills. The Diabetes Educator. 35(2):233-6, 238-41, 244-5. DOI: 10.1177/0145721709331945.

[24] Africa, S. S. (2006). Diabetes Education Training Manual. www.worlddiabetesfoundation.org.

[25] Rekha, V. B., Balasubramanian, R., Swaminathan, S., Ramachandran, R., Rahman, F., Sundaram, V., ... & Narayanan, P. R. (2007). Sputum conversion at the end of intensive phase of Category-1 regimen in the treatment of pulmonary tuberculosis patients with diabetes mellitus or HIV infection: An analysis of risk factors. Indian Journal of Medical Research, 126(5), 452-458.

[26] Odume, B., Falokun, V., Chukwuogo, O., Ogbudebe, C., Useni, S., Nwokoye, N., Aniwada, E., Olusola Faleye, B., Okekearu, I., Nongo, D., Odusote, T., & Lawanson, A. (2020). Impact of COVID-19 on TB active case finding in Nigeria. Public health action, 10(4), 157–162. https://doi.org/10.5588/pha.20.0037.

[27] Essar, M. Y., Nemat, A., Ahmad, S., Zil-E-Ali, A., Marzo, R. R., & Head, M. (2022). Highlighting the forgotten: Tuberculosis amidst the humanitarian crisis and COVID-19 in Afghanistan. Annals of medicine and surgery (2012), 77, 103671. https://doi.org/10.1016/j.amsu.2022.103671.

[28] Nwene E. K. (2016). Tuberculosis and gender in nigeria, sex differences in diagnosis and treatment outcome of tb and tb hiv infected patients. Texila international journal of public health ISSN: 2520-3134. DOI: 10.21522/TIJPH.2013.04.04.Art035.

[29] Enikuomehin, A., Kolawole, B. A., Soyoye, O. D., Adebayo, J. O., & Ikem, R. T. (2020). Influence of gender on the distribution of type 2 diabetic complications at the obafemi awolowo teaching hospital, Ile-Ife, Nigeria. African health sciences, 20(1), 294–307. https://doi.org/10.4314/ahs.v20i1.35.