Department of Global Health

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Browsing Department of Global Health by Subject "Adults"

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    The association between tuberculosis and the development of insulin resistance in adults with pulmonary tuberculosis in the Western Sub-District of the Cape Metropole region
    (Stellenbosch : Stellenbosch University, 2015-12) Philips, Lauren; Visser, Janicke; Blaauw, Renee; Nel, D. G.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Human Nutrition.
    ENGLISH SUMMARY : Introduction: The existence of a bi-directional relationship between tuberculosis (TB) and insulin resistance (IR)/diabetes has been alluded to in literature. Although diabetes has been linked to increased TB risk, the relationship between TB as a causative factor for IR remains unclear. The study aimed to determine if an association existed between TB and IR development in adults with newly diagnosed pulmonary tuberculosis (PTB) at baseline. It was additionally aimed to document changes in IR status during follow-up. Methods: This observational, cross-sectional study evaluated ambulatory participants at baseline for IR prevalence via anthropometrical and biochemical measures, together with diagnostic IR tests [homeostasis model assessment–IR (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI)]. In addition, a prospective cohort sub-section study was performed on approximately half of the baseline study population (n=29), who were followed-up at two and five months whilst on TB treatment. Summary statistics, correlation co-efficients and appropriate analysis of variance were used to describe and analyse data. Participants were excluded if they presented with other forms of TB, were HIV-positive, obese or had any pre-disposing IR conditions such as diabetes or metabolic syndrome. Results: A total of 59 participants were included from August 2013 until December 2014. The majority of participants were male (81.4%) and the mean age was 33.95 ±12.02 years. The prevalence of IR was 25.4% at baseline, determined by using a calculated HOMA-IR cut-off point of 2.477. Patients with IR were shown to be younger (p=0.04) and had a higher fasting insulin level (p<0.01). Although the difference between IR levels in participants between baseline and follow-up was not significant, a decrease was experienced over time. Most participants (61.0%) presented with a normal BMI at baseline and the majority of anthropometrical measurements showed a significant increase over the follow-up period, mainly in the first two months of treatment. The majority of participants (84.7%) had an increased mean CRP (60.18 ±50.92 mg/L) and decreased mean HDL-cholesterol level [69.5% (males: 0.94 ±0.88 mmol/L; females: 1.14 ±0.88 mmol/L)] at baseline. Mean baseline values of fasting glucose and albumin were within normal ranges (4.82 ±0.80 mmol/L and 39.32 ±4.35 g/L respectively). According to fasting glucose levels at baseline, 1.7% and 3.4% of participants presented with impaired fasting glucose and diabetes mellitus respectively. Several biochemical markers (CRP, albumin and white cell count) showed an improvement during the follow-up period. Conclusion: The study found an association between TB and IR development in newly diagnosed PTB patients. Many anthropometrical and biochemical measures showed improvements with time, especially during the intensive phase of treatment. Although not significant, IR levels decreased over time, which could be indicative of a clinical improvement. IR participants were shown to be younger and had a higher fasting insulin measurement. A high prevalence of IR among TB patients therefore highlights the need for early identification in order to facilitate a reversal of IR and prevent possible IR-related complications.