Screening of patients with tuberculosis for diabetes mellitus in China.
Harries, A D
AffiliationClinical Center on Tuberculosis, China CDC, Beijing, China; China Office, International Union Against Tuberculosis and Lung Disease, Beijing, China; Guangzhou Chest Hospital, Guangzhou, Guangdong Province, China; Xinjiang Chest Hospital, Urumuqi, Xinjiang, China; Shenyang Chest Hospital, Shenyang, Liaoning Province, China; Anding District CDC, Dingxi, Gansu Province, China ;Shandong Chest Hospital, Jinan, Shandong Province, China; Medecins sans Frontieres, Medical Department, Operational Research Unit, Brussels Operational Center, Luxembourg, Luxembourg; World Diabetes Foundation, Gentofte, Denmark; Stop-TB Department, World Health Organization, Geneva, Switzerland; International Union Against Tuberculosis and Lung Diseases, Paris, France; London School of Hygiene and Tropical Medicine, London, UK.
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AbstractObjective There is a high burden of both diabetes (DM) and tuberculosis (TB) in China, and this study aimed to assess feasibility and results of screening patients with TB for DM within the routine healthcare setting of six health facilities. Method Agreement on how to screen, monitor and record was reached in May 2011 at a stakeholders' meeting, and training was carried out for staff in the six facilities in July 2011. Implementation started in September 2011, and we report on 7 months of activities up to 31 March 2012. Results There were 8886 registered patients with TB. They were first asked whether they had DM. If the answer was no, they were screened with a random blood glucose (RBG) followed by fasting blood glucose (FBG) in those with RBG ≥ 6.1 mm (one facility) or with an initial FBG (five facilities). Those with FBG ≥ 7.0 mm were referred to DM clinics for diagnostic confirmation with a second FBG. Altogether, 1090 (12.4%) patients with DM were identified, of whom 863 (9.7%) had a known diagnosis of DM. Of 8023 patients who needed screening for DM, 7947 (99%) were screened. This resulted in a new diagnosis of DM in 227 patients (2.9% of screened patients), and of these, 226 were enrolled to DM care. In addition, 575 (7.8%) persons had impaired fasting glucose (FBG 6.1 to <7.0 mm). Prevalence of DM was significantly higher in patients in health facilities serving urban populations (14.0%) than rural populations (10.6%) and higher in hospital patients (13.5%) than those attending TB clinics (8.5%). Conclusion This pilot project shows that it is feasible to screen patients with TB for DM in the routine setting, resulting in a high yield of patients with known and newly diagnosed disease. Free blood tests for glucose measurement and integration of TB and DM services may improve the diagnosis and management of dually affected patients.