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cohort·public health, epidemiology, endocrinology, internal medicine, family medicine·PMC10519082

How can tuberculosis services better support patients with a diabetes co-morbidity? A mixed methods study in the Philippines

BMC Health Services Research · 6 authors, 8 centres

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TL;DR

This mixed-methods study, embedded in a prospective cohort, investigated the experiences and challenges of diabetes self-care among 31 tuberculosis patients in the Philippines.

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Among 189 diabetic participants, longitudinal blood glucose data identified glycaemic control status, informing the purposive sampling of 31 individuals for qualitative interviews. Results showed participants had knowledge of diabetes but low awareness of its impact on TB outcomes. Key enablers included free glucose-lowering medications through TB clinics. However, participants reported fear of medication side effects, preference for phytotherapy, and that the financial and physical burdens of TB hindered diabetes self-care. Limitations include potential lack of data saturation, recall bias for some participants, and challenges with remote interviews.

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cohort

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public health

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ORIGINAL PAPER

PMC10519082

How can tuberculosis services better support patients with a diabetes co-morbidity? A mixed methods study in the Philippines

BMC Health Services Research

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ABSTRACT

Abstract Background People with diabetes mellitus (DM) have an estimated two- to three-times greater risk of adverse tuberculosis (TB) treatment outcomes compared to those without DM. Blood glucose control is a primary aim of managing DM during TB treatment, yet TB programmes are not generally adapted to provide DM services. The purpose of this study was to understand perceptions and the lived experiences of diabetic patients in TB treatment in the Philippines, with a view to informing the development of disease co-management strategies. Methods This mixed methods study was conducted within a prospective cohort of adults newly-starting treatment for drug-sensitive and drug-resistant TB at 13 public TB clinics in three regions of the Philippines. Within the subset of 189 diabetic persons who self-reported a prior DM diagnosis, or were diagnosed by screenings conducted through the TB clinic, longitudinal blood glucose data were used to ascertain individuals’ glycaemic control (controlled or uncontrolled). Univariable logistic regression analyses exploring associations between uncontrolled glycaemia and demographic and clinical factors informed purposive sampling of 31 people to participate in semi-structured interviews. All audio-recorded data were transcribed and thematic analysis performed. Results Participants — both with controlled and uncontrolled blood glucose — were knowledgeable about diabetes and its management. However, a minority of participants were aware of the impact of DM on TB treatment and outcomes. Many participants newly-diagnosed with DM at enrolment in TB treatment had not perceived any diabetic symptoms prior and would have likely not sought clinical consult otherwise. Access to free glucose-lowering medications through TB clinics was a key enabling resource. However, participants expressed fear of side effects and interrupted access to glucose-lowering medications, and a preference for phytotherapy. Many participants felt that physical and financial impacts of TB and its treatment were challenges to DM management. Conclusions and recommendations Results of this study indicate that public TB clinics can provide diabetic patients with additional health care resources and education to address co-morbidity. TB programmes might consider identifying patients with complicated DM, and offering diabetic monitoring and management, as DM and diabetic complications may compound the burden of TB and its treatment. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-023-10015-7. Keywords: Diabetes, Tuberculosis, TB-DM, Co-morbidity, Integrated care, Self-care, Philippines, Southeast Asia

CITATION EXPORT

Lauren Oliveira Hashiguchi, Sharon E Cox, Tansy Edwards et al.. How can tuberculosis services better support patients with a diabetes co-morbidity? A mixed methods study in the Philippines. BMC Health Services Research. (2023). https://doi.org/10.1186/s12913-023-10015-7

AUTHORS

6 · 8 CENTRES

Lauren Oliveira Hashiguchi, Sharon E Cox, Tansy Edwards, Mary C Castro, Mishal Khan, Marco Liverani

1National Institute of Nursing Research, National Institutes of Health, 31 Center Drive, Bethesda, MD 20892-2178 USA
2Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
3School of Tropical Medicine & Global Health, Nagasaki University, 1 Chome-12-4 Sakamoto, Nagasaki, 852-8523 Japan
4Faculty of Epidemiology & Population Health, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
5United Kingdom Health Security Agency, 61 Colindale Avenue London NW9 5EQ, Collindale, UK
6MRC International Statistics and Epidemiology Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT UK
7Nutrition Center Philippines, Muntinlupa City, Manila Philippines
8Aga Khan University, National Stadium Road, Karachi, 74800 Pakistan