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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