Temporal patterns of tuberculosis-associated hyperglycaemia and its effect on treatment outcomes in individuals not previously diabetic: A prospective cohort study
7 affiliations
- 1Department of Medical Microbiology and Immunology, University of Nairobi, Kenya
- 2KAVI-Institute of Clinical Research, University of Nairobi, Kenya
- 3Tuberculosis and HIV Co-infection Training Program, Kenya
- 4Department of Veterinary Medicine, University of Helsinki, Finland
- 5Department of Paediatrics and Child Health, University of Nairobi, Kenya
- 6Rhodes Chest Clinic, Nairobi, Kenya
- 7Department of Applied Health Sciences, University of Birmingham, United Kingdom
Abstract
Background: Active tuberculosis (TB) infection can induce hyperglycaemia and insulin resistance, increasing the risk of type 2 diabetes mellitus and worsening TB disease severity. However, data on the dynamics of TB-associated hyperglycaemia and its effect on TB treatment outcomes among individuals not previously diabetic remain limited, particularly in high TB-burden settings. In this study, we aimed to investigate the prevalence and temporal patterns of TB-associated hyperglycaemia and its impact on disease presentation and TB treatment outcomes among a cohort of individuals not previously diabetic. Methods: This was a five-month longitudinal prospective cohort study conducted at two urban specialized TB healthcare facilities in Kenya among adults aged >18 years with bacteriologically confirmed pulmonary TB (PTB). Known diabetes mellitus (DM) or prediabetic individuals were excluded during enrolment. Glycaemic status was assessed at baseline and months two and five using glycated haemoglobin (HbA1c) according to the American Diabetes Association guideline. Hyperglycaemia was defined as HbA1c ≥5.7% and categorized as normoglycaemia, persistent, transient, or incident hyperglycaemia based on longitudinal measurements. Socio-demographic and clinical data were collected using a structured questionnaire and analysed using SPSS version 26.0 and GraphPad Prism version 9.0. Longitudinal trends in HbA1c levels and the association of hyperglycaemia with DM-related symptoms, as well as TB treatment outcomes, were assessed using the Friedman test and the Generalized Estimating Equations (GEE), respectively. Results: We enrolled and followed 87 individuals newly diagnosed with PTB. Of these, 66 were tested for hyperglycaemia in month two after 7 died and 14 were lost to follow-up/transferred out (LTFU/TO), and 70 in month 5, after an additional death, 7 re-engagements, and 2 LTFU/TO were reported. At enrolment, the cohort was predominantly male (76%), not married (53%), and HIV-negative (84%), with a median age of 37 years (IQR 29–44). Prevalence of hyperglycaemia at baseline was 75% (95% Confidence Interval [CI] 65–83), with 45% of the individuals presenting as prediabetic and 30% as diabetic. At the month-two and month-five time points, the proportion of participants with prediabetes (pre-DM) increased from 24% (16/66) to 30% (21/70), while the prevalence of DM declined from 21% (14/66) to 9% (6/70). Across the time points, HbA1c levels varied significantly (p < 0.001). In GEE analysis, hyperglycaemic participants were more likely to experience classic symptoms of DM such as frequent micturition (adjusted Relative Risk [aRR] 1.76, 95% CI 1.12–2.77), increased thirst (aRR 2.37, 95% CI 1.38–4.05), unintentional weight loss (aRR 1.84, 95% CI 1.24–2.75), and blurred vision (aRR 1.95, 95% CI 1.20–3.18). After adjusting for age, BMI, HIV, alcohol use, and smoking, hyperglycaemia was independently associated with an increased risk of sputum positivity (aRR 4.22, 95% CI 2.09–8.52). Glycaemic variability was significantly associated with unfavourable TB treatment outcomes (p < 0.001). Conclusions: New-onset hyperglycaemia was highly prevalent in adults newly diagnosed with TB and persisted through the fifth month of TB treatment. Hyperglycaemia was associated with classic diabetic symptoms and persisting sputum positivity, highlighting the need to integrate glycaemic monitoring and management into routine TB follow-up care.
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BibTeX
@article{musyoki2026temporal,
title = {{Temporal patterns of tuberculosis-associated hyperglycaemia and its effect on treatment outcomes in individuals not previously diabetic: A prospective cohort study}},
author = {Victor Moses Musyoki and Marianne Mureithi and Annamari Heikinheimo and Elizabeth Maleche-Obimbo and Dishon Maina and Susan Musau and Ruth Maganga and Omu Anzala and Kariuki Njaanake},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358593},
url = {https://doi.org/10.1371/journal.pone.0358593},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Temporal patterns of tuberculosis-associated hyperglycaemia and its effect on treatment outcomes in individuals not previously diabetic: A prospective cohort study
AU - Victor Moses Musyoki
AU - Marianne Mureithi
AU - Annamari Heikinheimo
AU - Elizabeth Maleche-Obimbo
AU - Dishon Maina
AU - Susan Musau
AU - Ruth Maganga
AU - Omu Anzala
AU - Kariuki Njaanake
PY - 2026
DA - 2026/09/15
JO - PLOS One
DO - 10.1371/journal.pone.0358593
UR - https://doi.org/10.1371/journal.pone.0358593
AB - Background: Active tuberculosis (TB) infection can induce hyperglycaemia and insulin resistance, increasing the risk of type 2 diabetes mellitus and worsening TB disease severity. However, data on the dynamics of TB-associated hyperglycaemia and its effect on TB treatment outcomes among individuals not previously diabetic remain limited, particularly in high TB-burden settings. In this study, we aimed to investigate the prevalence and temporal patterns of TB-associated hyperglycaemia and its impact on disease presentation and TB treatment outcomes among a cohort of individuals not previously diabetic. Methods: This was a five-month longitudinal prospective cohort study conducted at two urban specialized TB healthcare facilities in Kenya among adults aged >18 years with bacteriologically confirmed pulmonary TB (PTB). Known diabetes mellitus (DM) or prediabetic individuals were excluded during enrolment. Glycaemic status was assessed at baseline and months two and five using glycated haemoglobin (HbA1c) according to the American Diabetes Association guideline. Hyperglycaemia was defined as HbA1c ≥5.7% and categorized as normoglycaemia, persistent, transient, or incident hyperglycaemia based on longitudinal measurements. Socio-demographic and clinical data were collected using a structured questionnaire and analysed using SPSS version 26.0 and GraphPad Prism version 9.0. Longitudinal trends in HbA1c levels and the association of hyperglycaemia with DM-related symptoms, as well as TB treatment outcomes, were assessed using the Friedman test and the Generalized Estimating Equations (GEE), respectively. Results: We enrolled and followed 87 individuals newly diagnosed with PTB. Of these, 66 were tested for hyperglycaemia in month two after 7 died and 14 were lost to follow-up/transferred out (LTFU/TO), and 70 in month 5, after an additional death, 7 re-engagements, and 2 LTFU/TO were reported. At enrolment, the cohort was predominantly male (76%), not married (53%), and HIV-negative (84%), with a median age of 37 years (IQR 29–44). Prevalence of hyperglycaemia at baseline was 75% (95% Confidence Interval [CI] 65–83), with 45% of the individuals presenting as prediabetic and 30% as diabetic. At the month-two and month-five time points, the proportion of participants with prediabetes (pre-DM) increased from 24% (16/66) to 30% (21/70), while the prevalence of DM declined from 21% (14/66) to 9% (6/70). Across the time points, HbA1c levels varied significantly (p < 0.001). In GEE analysis, hyperglycaemic participants were more likely to experience classic symptoms of DM such as frequent micturition (adjusted Relative Risk [aRR] 1.76, 95% CI 1.12–2.77), increased thirst (aRR 2.37, 95% CI 1.38–4.05), unintentional weight loss (aRR 1.84, 95% CI 1.24–2.75), and blurred vision (aRR 1.95, 95% CI 1.20–3.18). After adjusting for age, BMI, HIV, alcohol use, and smoking, hyperglycaemia was independently associated with an increased risk of sputum positivity (aRR 4.22, 95% CI 2.09–8.52). Glycaemic variability was significantly associated with unfavourable TB treatment outcomes (p < 0.001). Conclusions: New-onset hyperglycaemia was highly prevalent in adults newly diagnosed with TB and persisted through the fifth month of TB treatment. Hyperglycaemia was associated with classic diabetic symptoms and persisting sputum positivity, highlighting the need to integrate glycaemic monitoring and management into routine TB follow-up care.
SN - 1932-6203
ER -