2010 tb regional meeting tb.diabetes

8/3/2019 2010 TB Regional Meeting TB.diabetes

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Shanica Alexander, MPH

CDC Public Health AdvisorISDH TB/Refugee Health Division


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Discuss the national and state epidemiology oftuberculosis disease (TB), diabetes mellitus (DM) andco-infection

Discuss the increased risk of individuals with latent TBinfection (LTBI) and diabetes mellitus progressing toactive TB disease

Discuss screening and treatment recommendations forindividuals with LTBI and DM


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0

1

2

3

4

5

6

2005 2006 2007 2008 2009

US

IN


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0.0

2.0

4.0

6.0

8.0

10.0

2005 2006 2007 2008 2009

Percent

IN

US


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Age distribution of Prevalence of Diabetes in Adults (18+), Indiana 2006-2009

18-24 25-34 35-44 45-54 55-64 65+

2006 1.0 2.0 5.0 6.6 14.7 19.9

2007 0.9 0.8 3.2 8.3 18.0 20.3

2008 1.1 3.9 3.9 9.4 18.0 21.2

2009 1.3 1.1 3.3 9.7 18.4 22.3

0.0

5.0

10.0

15.0

20.0

25.0

Percent


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0

2

4

6

8

10

12

14

16

White Black Hispanic Other Multi-racial

Percent

Prevalence of Diabetes in Adults by race and ethnicity (18+), Indiana 2009

2009


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In 2009, 12% of Indianas TB cases reported adiagnosis of diabetes mellitus

So far in 2010, 6% of Indianas TB casesreported a diagnosis of diabetes mellitus*

* As of 9/2/10


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5% of latent TB infected persons with normal immunesystem will develop active TB disease within first 2 yrs ofinfection

10% of LTBI persons with normal immune system willdevelop active TB disease at some point in life

Immune compromising medical conditions increase risk that

latent TB infection will progress to active TB disease

Studies suggest that infected persons with DM may be 3times more likely to progress to TB disease


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CDC Recommendations Clinicians should identify patients who are at higher risk for

TB exposure or progressing to TB disease once infected andTST should be given as part of routine evaluation

Persons with medical conditions that increase risk for TBdisease should receive TST and TST results should be clearlynoted in medical record

TST results 10mm = positive

If +TST, medical examination and CXR must be done toexclude TB disease.


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IHS Recommendations

TST administered to all adults with diabetes within oneyear of diabetes diagnosis if TST status is negative orunknown

If no TST since diabetes diagnosis, TST status shouldbe determined

To test is to treat!!!!


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CDC Recommendations

Careful assessment to rule out the possibility of TBdisease is necessary before initiation of LTBI treatment

Case contacts with immunocompromising conditions(TB disease excluded) are recommended for LTBItreatment regardless of TB history and documentation.

Person at high risk for TB and nonadherencesuspected, directly observed therapy should beconsidered Monitor glucose levels daily: 61.1% in IN, 63.6% in US


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IHS Recommendations

Treat

If known + TST, unless contraindicated

Diabetes and untreated LTBI

Even if 2 yrs since initial +TST

Even if 35 yrs old


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Individuals 25 yrs old are at higher risk for TB andDM

Non-white populations are at higher risk for TB and

DM

LTBI persons with DM are at higher risk of developingTB disease

Persons with DM should have an known TST status

DM persons with +TST should complete LTBItreatment


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Indiana State Department of Health Diabetes Prevention and ControlProgram. Indiana: Primary Prevention of Type 2 Diabetes, 2009.

Indiana State Department of Health Diabetes Prevention and ControlProgram. Indiana: Diabetes Facts At a Glance, 2009.

Indiana State Department of Health Tuberculosis Control Program.Indiana Tuberculosis Annual Summary, 2009.

Centers for Disease Control and Prevention (CDC). Core Curriculum on

Tuberculosis: What the Clinician Should Know. Fourth Edition, 2000

Controlling Tuberculosis in the United States Recommendations from theAmerican Thoracic Society, CDC, and the Infectious Diseases Society ofAmerica. MMWR 2005; 54 (No. RR-12)
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5412a1.htm

2010 tb regional meeting tb.diabetes

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