Screening patients with Diabetes Mellitus for Tuberculosis in China

• Published in: Tropical medicine & international health 2012-10, Vol.17 (10), p.1302-1308
• Main Authors: Lin, Yan, Li, Liang, Mi, Fengling, Du, Juan, Dong, Yaqiong, Li, Zhaoliang, Qi, Wenbo, Zhao, Xiangling, Cui, Ying, Hou, Fengying, Zachariah, Rony, Kapur, Anil, Lönnroth, Knut, Harries, Anthony D.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Ambulatory Care Facilities; Bacterial diseases; Biological and medical sciences; China; China - epidemiology; Chine; cribado; Diabetes Complications - diagnosis; Diabetes Complications - epidemiology; diabetes mellitus; Diabetes Mellitus - diagnosis; Diabetes. Impaired glucose tolerance; diabète sucré; dépistage; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; General aspects; Human bacterial diseases; Humans; Infectious diseases; Mass Screening - methods; Medical sciences; Pilot Projects; Prevalence; Referral and Consultation; screening; tuberculose; Tuberculosis; Tuberculosis - complications; Tuberculosis - diagnosis; Tuberculosis - drug therapy; Tuberculosis - epidemiology; Tuberculosis and atypical mycobacterial infections
• ISSN: 1360-2276; 1365-3156
• DOI: 10.1111/j.1365-3156.2012.03069.x

Objective  There is a high burden of both diabetes (DM) and tuberculosis (TB) in China, and as DM increases the risk of TB and adversely affects TB treatment outcomes, there is a need for bidirectional screening of the two diseases. How this is best performed is not well determined. In this pilot project in China, we aimed to assess the feasibility and results of screening DM patients for TB within the routine healthcare setting of five DM clinics. Method  Agreement on how to screen, monitor and record was reached in May 2011 at a national stakeholders meeting, and training was carried out for staff in the five clinics in July 2011. Implementation started in September 2011, and we report on 7 months of activities up to 31 March 2012. DM patients were screened for TB at each clinic attendance using a symptom‐based enquiry, and those positive to any symptom were referred for TB investigations. Results  In the three quarters, 72% of 3174 patients, 79% of 7196 patients and 68% of 4972 patients were recorded as having been screened for TB, resulting in 7 patients found who were already known to have TB, 92 with a positive TB symptom screen and 48 of these newly diagnosed with TB as a result of referral and investigation. All patients except one were started on anti‐TB treatment. TB case notification rates in screened DM patients were several times higher than those of the general population, were highest for the five sites combined in the final quarter (774/100 000) and were highest in one of the five clinics in the final quarter (804/100 000) where there was intensive in‐house training, special assignment of staff for screening and colocation of services. Conclusion  This pilot project shows that it is feasible to carry out screening of DM patients for TB resulting in high detection rates of TB. This has major public health and patient‐related implications. Objectif:  Le diabète sucré (DS) et la tuberculose (TB) constituent tous deux une lourde charge en Chine, et comme le DS augmente le risque de TB et affecte l’issue du traitement anti‐TB, il y a une nécessité pour le dépistage bidirectionnelle des deux maladies. La manière de réaliser cela au mieux n’est pas bien déterminée. Dans ce projet pilote en Chine, nous avons cherchéàévaluer la faisabilité et les résultats du dépistage de la TB chez les patients atteints de DS au sein des soins de santé de routine dans 5 cliniques de DS. Méthode:  L’accord sur la façon de dépister, de suivre et d’enregistrer les don