title: Establishing the association of type 2 diabetes and insulin resistance with Tuberculosis and Coronary Heart Diseases among euglycaemic and diabetic patients in Saudi Arabia
Creators: name: Almaleki, FH
Publisher: name: University of Liverpool Repository
Year: 2019

description: Background: Patients with Coronary Heart Disease (CHD) or Tuberculosis (TB) are more likely to have Type 2 Diabetes Mellitus (T2DM). Insulin Resistance (IR) in patients with normal glucose may also be a risk factor for these conditions. Methods: This thesis explored whether T2DM and IR are risk factors for TB enrolled patients receiving TB treatment in the previous year and controls. In addition, the thesis explores whether T2DM and IR are risk factors for CHD among patients with stable CHD and controls. The studies were based in Saudi Arabia and used cross sectional surveys and case controls design. Controls were asymptomatic adults attending the TB clinics for labour reasons. All participants were screened for fasting plasma glucose (FPG), insulin, glycated haemoglobin (HbA1c) and lipids. We assessed the severity of the clinical presentation of TB among patients with T2DM, IR and normal glucose. Finally, we described the quality of life of patients with CHD among patients with T2DM, IR and normal glucose. Results: One hundred seventy-five adults with pulmonary TB and 140 controls were recruited (36.6% and 40.7% female and 63.4% and 59.3% male, respectively). Twenty-nine per cent of TB cases had T2DM and 22% normoglycemic IR. 3.3% of patients were unaware of their T2DM diagnosis. TB was associated with prediabetes (AOR 5.112, p = 0.032), low level of risky HDL Cholesterol (AOR 0.316, p = 0.001) and non-Saudi nationalities (AOR 4.018, p ˂ 0.001). Former TB cases were more likely to eat fast foods (1 – 2 times/week, AOR 2.857 and 2 – 3 times/month, AOR 3.126, p = 0.026, respectively) and to have a fair or poor diet (AOR 13.518, and AOR 37.766, respectively) (p ˂ 0.001). Three hundred twenty-five patients with stable CHD and were recruited (29.2% and 39.9% female and 70.8% and 60.1% male, respectively). Of these 65% had T2DM and 31.3% normoglycemic IR. Almost 6% of patients were unaware of their T2DM status. CHD were more likely to have T2DM (AOR 4.974, p = 0.034), high FPG (AOR 5.034, p = 0.021), to be male (AOR 9.950, p ˂ 0.001), aged above 50 years old (p ˂ 0.015), Saudi (AOR 6.879, p = 0.002), to have primary education (AOR 20.315, p = 0.004), hypertension (AOR 5.920, p = 0.003) and to take lipid lowering medications (AOR 24.516, p ˂ 0.001) than controls. Cases were more likely to have high WHR (AOR 33.997, p ˂ 0.001) and diastolic BP (AOR 1.080, p = 0.004) than controls. CHD-IR cases had lower quality of life and satisfaction scores with bodily appearance (p = 0.003), overall perception of satisfaction with themselves (p = 0.041) and score in the psychological domains (p = 0.006) than controls. Patients with CHD and T2DM had lower overall scores for quality of life (p = 0.002), satisfaction with bodily appearance (p = 0.012), overall perception of satisfaction with themselves (p = 0.015), with access to health services (p = 0.049) and satisfaction score with transport (p = 0.027) than controls. Conclusion: TB was more prevalent among non-Saudi nationals and males. Patients with TB were more likely to have T2DM, and to be prediabetic, but not more likely to have IR than controls. More efforts are required to upscale the detection of T2DM among TB patients. Patients with CHD were more likely to be male and to have T2DM and IR than controls. Patients with CHD and IR had a lower quality of life than controls. More efforts are required to upscale the management of T2DM and IR among CHD patients.