Background: American Indian (AI) patients with type 2 diabetes have a three to five fold greater risk for progression to active tuberculosis (TB) than patients without diabetes. Indian Health Service (IHS) guidelines recommend that all patients with diabetes be administered PPD tuberculin skin tests. If positive and not previously prophylaxed, patients should receive isoniazid (INH) therapy to prevent progression to TB disease. To monitor clinical care of patients with diabetes, the IHS Diabetes Program annually audits a national sample of patient records. Method: We evaluated screening and treatment of TB among AI patients with diabetes for 1995-98 using data from this audit. Patients were assigned to one of the following four categories: PPD positive / treated, PPD negative, PPD status unknown (inadequate screening), and PPD positive / untreated (inadequate treatment). We evaluated trends over time and regional differences by IHS service areas. Results: Nationally, the porportion of inadequately screened patients showed no decline over the 4-year period (range: 36%-38%), not did the proportion of inadequately treated patients decline (range:19%-20%). In 1998, 57% of patients with diabetes were inadequately screened or treated. Clinic variation in the inadequately screened group ranged from 12% to 76%, and in the inadequately treated group range from 6% to 31%. Conclusion: Active TB could be prevented in some AI patients by improved screening and prophylaxis in patients with diabetes. Because diabetes incidence continues to increase in AI populations, TB morbidity and mortality may also increase unless screening and prophylaxis improve.
Learning Objectives:
Keywords: Diabetes, Tuberculosis
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Indian Health Service Diabetes Audit
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.