Shamaila Burney, Omer Awwab Khan, Saerah Iffat Zafar.
Effect of Glycemic Control on Radiological Manifestations of Pulmonary Tuberculosis – A Hospital Based Study.
J Islamic Int Med Coll Jan ;11(2):52-6.

Objectives: ! To study the frequency of diabetes in patients with active pulmonary tuberculosis. ! To determine the impact of diabetes on radiological findings in tuberculosis. ! To study the association of atypical radiological manifestations with glycemic control in diabetes associated tuberculosis. Study Design: A Descriptive study. Place and Duration of Study: The study was conducted in Medical Department of Pakistan Air Force Hospital Mianwali from August 2013 to July 2014. Materials and Methods: Seventy five new cases (18 years and above) of active pulmonary tuberculosis were selected by non-consecutive convenient sampling. All patients received standard anti-tuberculous treatment (ATT) for six months. Fasting blood glucose and chest X-ray were performed in all patients. Glycosylated hemoglobin (HbA1c levels) were checked to assess the glycemic control in diabetic patients. Radiographic features of the two groups; diabetic vs. non diabetic and within diabetic population; poor vs. optimal glycemic control, were then compared. Results: Thirty three (33/75 or 44%) patients were found to be diabetic. Radiological changes were more frequently atypical in diabetic group as compared to non diabetic population (21/33 or 63.6% vs. 8/42 or 19%). Nine of the 12 diabetic patients with poor glycemic control i.e. HbA1c levels >7% had cavitations, lower zone involvement and bilateral changes as compared to 11/21 patients with optimal glucose control i.e. HbA1c <7% and the difference was significant (9/12 or75% vs.11 /21 or 52.3%, p value <0.001). Conclusion: A high index of suspicion for diagnosis of diabetes is required for TB patients with atypical radiological manifestations. Poor glycemic control is related with atypical findings on chest X-ray in pulmonary tuberculosis.

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