Diabetes Mellitus, Type 2 Clinical Trial
Official title:
Evaluation of an Integral Strategy for Joint Management of DM2 and Pulmonary TB in Orizaba, Veracruz.
The objective of this study is to evaluate an integral strategy in which diabetes mellitus 2 (DM2) and pulmonary tuberculosis (TB) are managed together. The researchers propose a community intervention with two arms in 4 health centers in Orizaba, Veracruz. Patients will be assigned to either arm by convenience. One arm will receive the joint treatment strategy and another the routine treatment used in health services.
In Mexico DM2 is the main complication of patients with TB (22.2%), more so than HIV,
malnutrition and chronic pulmonary obstructive disease (COPD).
The World Health Organization (WHO) has proposed a framework for the joint management of TB
and DM2 and one of the key points is the need for studies that evaluate the viability and
efficacy of programs that manage both diseases jointly. There are social and clinical
determinants that are associated to a higher mortality in patients with DM2 and TB such as
poor glucose level control (glycosylated hemoglobin >7mg/dl) and immunosuppression which in
turn increases the risk of developing a recurrent episode of TB, being multi drug resistant
(MDR) and/or failing TB treatment. The determinants associated to TB are the lack of
awareness of the disease, drug toxicity and interaction with DM2 medication and treatment
default. Social determinants are low income level, living in a crowded household, living in
rural areas, not having access to health care, having been in prison and living with people
with TB.
The strategy consists of interventions on patients, health personnel, community health
workers and directors of health services. Researchers will train patients in the use of
glucometers, health personnel in management of comorbidities of DM2 and TB, health workers in
how to support patients and increase treatment adherence. Bidirectional screening in patients
with TB or DM2 using bacilloscopies and glycosylated hemoglobin (HbA1c). During the 6 months
of directly observed treatment (DOTS) study nurses will monitor levels of glucose weekly with
capillary glucose, monthly with fasting glucose, in months 1, 3 and 6 with HbA1c. Patients
with high glucose levels will be referred to metabolic control which will be assessed by
experts. Regarding DOTs, first line TB drugs will be available and study nurses will
supervise that they are taken correctly. A nutritionist will carry out home visits to guide
dietary intake.
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