Sains Malaysiana 49(5)(2020): 1081-1088

http://dx.doi.org/10.17576/jsm-2020-4905-12

Tuberculosis and Associated Factors among Type 2 Diabetic Patients in Perak: A Case Control Study

(Tuberkulosis dan Faktor Berkaitan dalam Kalangan Pesakit Diabetis Jenis 2 di Perak: Suatu Kajian Kes Kawalan)

KUI CHOON YONG¹, NOOR AZIMAH MUHAMMAD²*, WEI-YIN LIM³ & AMAR-SINGH HSS³

¹Klinik Kesihatan Buntong, Persiaran Desa Rishah 2, 30100 Ipoh, Perak Darul Ridzuan, Malaysia

²Department of Family Medicine, Faculty of Medicine, Hospital Canselor Tuanku Muhriz,

Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak,

56000 Cheras, Kuala Lumpur, Federal Territory, Malaysia

³Clinical Research Centre Perak, Ministry of Health, 30100 Ipoh, Perak Darul Ridzuan, Malaysia

Diserahkan: 31 Julai 2019/Diterima: 29 Januari 2020

ABSTRACT

This is a case-control study conducted with diabetic patients in Kinta, Kampar and Larut-Matang-Selama districts of Perak, Malaysia. We intended to determine the factors contributing to the development of active tuberculosis among diabetes patients. Cases were culture-proven and registered in the Malaysian National Tuberculosis Surveillance Registry (MyTB) from 2012 to 2018. Controls were diabetes patients identified from the National Diabetes Registry and were matched with cases based on the clinic in which they were registered at a ratio of 1:1. 119 cases and 119 controls were included in this study. Multivariate analysis was used to identify clinical factors associated with tuberculosis. Patient had increased odds of having tuberculosis if they had higher glycaemic (HbA1c) levels (OR=1.41, 95% CI 0.22-0.96, p<0.001) or nephropathy (OR=8.91, 95% CI 2.31-34.05, p<0.001). The odds ratio was lower if they have diabetes for at or more than 5 years (OR=0.46, 95% CI 0.22-0.96, p=0.04) and older (OR=0.96, CI 0.92-0.99, p=0.02). In conclusion, this study suggests that routine screening for tuberculosis in patients with diabetes should consider the diabetic duration, glycemic control, presence of nephropathy, and age of the patient.

Keywords: Case-control study; diabetic associated factors; diabetic nephropathy; type 2 diabetes mellitus; tuberculosis

ABSTRAK

Ini adalah sebuah kajian kes kawalan yang melibatkan pesakit diabetes di daerah Kinta, Kampar dan Larut-Matang-Selama Perak, Malaysia. Kajian ini bertujuan untuk menentukan faktor yang menyumbang kepada perkembangan tuberkulosis aktif dalam kalangan pesakit diabetes. Kes bermaksud pesakit yang terbukti mendapat jangkitan tuberkulosis melalui kultur yang didaftarkan di Sistem Maklumat Tuberkulosis Kebangsaan (MyTB) dari tahun 2012 hingga 2018. Kawalan adalah pesakit diabetes yang dikenal pasti daripada Sistem Maklumat Diabetes Kebangsaan dan dipadankan dengan kes berdasarkan klinik dengan pesakit-pesakit tersebut didaftarkan dan dalam nisbah 1: 1. Kajian ini melibatkan 119 kes dan 119 kawalan. Analisis multivariat digunakan untuk mengenal pasti faktor klinikal yang berkaitan dengan tuberkulosis. Pesakit berisiko untuk tuberkulosis jika mereka mempunyai tahap glisemik (HbA1c) yang tinggi (OR=1.41, 95% CI 0.22-0.96, p<0.001) atau masalah ginjal (OR=8.91, 95% CI 2.31-34.05, p<0.001). Kebarangkalian pesakit untuk mendapat tuberkulosis berkurangan sekiranya mereka mempunyai diabetes 5 tahun atau lebih (OR=0.46, 95% CI 0.22-0.96, p=0.04) dan berumur (OR=0.96, CI 0.92-0.99, p=0.02). Kesimpulannya, kajian ini menunjukkan bahawa pemeriksaan rutin tuberkulosis pada pesakit diabetes harus mempertimbangkan tempoh diabetes, kawalan glisemik, keadaan ginjal dan usia pesakit.

Kata kunci: Diabetes; faktor berkaitan diabetes; kajian kes kawalan; masalah ginjal; tuberkulosis

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*Pengarang untuk surat-menyurat; email: drazimah@ppukm.ukm.edu.my