Screening for Diabetes and Latent TB Infections; Decreasing the Global Burdon

About the Program

Category: Health (Best in Category)

Year: 2017

Identification and treatment at the early stage of tuberculosis (TB) infection is critical to TB elimination in the United States. Researchers have demonstrated a bidirectional association between TB and diabetes mellitus (DM). For persons with latent TB infection (LTBI), the risk of converting to active TB disease increases three fold among DM. Unfortunately, many patients at risk of DM are unaware of their status. In April 2016, the Oakland County Health Division implemented a practice to test hemoglobin A1C (HbA1c) for every new and existing LTBI patient. Our preliminary study showed that 55% of LTBI patients were pre-diabetic or diabetic (hyperglycemic), but only 13% knew their status before testing. Additionally, we found that the mean BMI in the study population was 25, and of an age where an HbA1c otherwise would not be recommended according to the United States Preventative Services Task Force(USPSTF) guidelines. To continue and expand on this work, OCHD has invited the other Michigan health departments to join the investigation by screening for hyperglycemia among their LTBI patients in order to: 1. Ascertain the prevalence of hyperglycemia in the LTBI population of a low incidence state in order to identify those persons with a threefold increase in the risk of developing active TB disease. The heightened awareness can serve to educate not only the patient, but also community providers, to have a heightened suspicion for conversion to active TB disease. 2. Ascertain what factors can improve acceptance of early LTBI treatment and provide enhanced nursing education to regarding this increased risk to LTBI patients to encourage acceptance of treatment