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"ABSTRAK Latar belakang : Prevalens diabetes melitus (DM) terus meningkat di negaraberkembang yang merupakan negara endemis tuberkulosis (TB). Diabetes melitusmeningkatkan risiko infeksi, hambatan konversi sputum dan kegagalanpengobatan TB. Penelitian ini bertujuan menganalisis faktor-faktor yangmempengaruhi konversi sputum Basil Tahan Asam (BTA) mikroskopik padaakhir bulan kedua pengobatan TB pada pasien TB paru kasus baru dengan DM.Metode : Penelitian kohort retrospektif ini dilaksanakan di RSUP Perahabatanterhadap pasien-pasien TB paru BTA positif kasus baru dengan DM yang berobatpada periode Juli 2012 sampai Juni 2015. Hubungan faktor risiko dengan konversisputum BTA mikroskopik dianalisis dengan analisis bivariat dan multivariat.Hasil penelitian: Proporsi kegagalan konversi sputum BTA mikroskopik padapasien TB paru kasus baru dengan DM adalah 43,04%, sedangkan pada pasientanpa DM 22,75% (p<0,001, KI95% 0,11-0,30) dan risiko relatif (RR) kegagalankonversi 1,89 kali lebih tinggi pada kelompok DM. Faktor risiko yang meningkatbermakna pada pasien gagal konversi adalah kadar kepositifan sputum BTAsebelum terapi (p=0,021), HbA1c (p=0,014), GDP (p=0,047), GD 2jam PP(p=0,030) dan kavitas pada foto toraks (p=0,033) sedangkan albumin serum lebihrendah bermakna (p=0,013). Analisis multivariat mendapatkan faktor risikoterkuat untuk kegagalan konversi sputum adalah kadar albumin serum yangrendah (p=0,046, aOR 0,464, KI95% 0,218-0,986), tingkat kepositifan sputumBTA mikroskopik sebelum terapi yang tinggi (p=0,009, aOR 2,313, KI95%1,230-4,349) dan kadar HbA1c yang tinggi (p=0,018, aOR 1,298, KI 95% 1,047-1,610).Kesimpulan: Tingkat kepositifan sputum BTA sebelum terapi yang tinggi, statuskontrol DM yang tidak baik, kavitas pada foto toraks dan kadar albumin serumyang rendah meningkatkan risiko kegagalan konversi sputum BTA pada pasienTB dengan DM.ABSTRACT Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients.;Background: The link of DM and TB is more prominent in developing countrieswhere TB is endemic and the burden of DM is increasing. Diabetes mellitusincreases the risk of TB infection, delayed sputum smear conversion and TBtreatment failure. This study would like to evaluate factors associated withdelayed sputum smear conversion in the end of two months of TB treatment innew cases TB with DM patients in Persahabatan Hospital.Methods: This retrospective cohort study was conducted in PersahabatanHospital, included all new cases TB with DM patients in the period from July2012 - June 2015. All the risk factors performed bivariate and multivariateanalysis in association with sputum smear conversion in the end of two months ofTB treatment.Results: The proportion of sputum smear conversion failure is higher in TB-DMthan non-DM patients (43,04 vs 22,75%) (p<0,001, CI95% 0,11-0,30) with therelative risk (RR) for sputum conversion failure 1,89 higher in TB-DM patients.Bivariate analysis resulted in significant higher of initial sputum smear level(p=0,021), HbA1c (p=0,014), FBG (p=0,047), post prandial Blood Glucose(p=0,030) and cavity at chest x-ray (p=0,033) and significant lower of serumalbumin (p=0,013) in non-conversion patients. Multivariate analysis resulted inrisk factors strongly associated with sputum conversion failure are low albuminlevel (p=0,046, CI95% 0,218-0,986), high initial sputum smear level (p=0,009,CI95% 1,230-4,349) and high HbA1c level (p=0,018, CI 95% 1,047-1,610).Conclusions: Higher initial sputum smear level, uncontrolled diabetic status,cavity at chest x-ray and lower albumin level associated with sputum smearconversion failure in TB-DM patients."

"Latar belakang dan tujuan: diabetes termasuk dalam 8 faktor risiko tertinggi berkembangnya tuberkulosis (TB). Diabetes melitus (DM) meningkatkan risiko TB 3 kali, sedangkan infeksi TB memperburuk kontrol glikemik pasien DM dengan risiko kegagalan terapi TB 69% dan relaps 4 kali. Strategi pengobatan optimal untuk pasien TB-DM belum ditemukan, pengelolaan TB-DM sama dengan pasien TB non-DM. Sejak 2017, WHO tidak lagi merekomendasikan pemberian obat intermiten pada fase lanjutan karena risiko kegagalan terapi, kekambuhan, dan resistensi obat yang lebih tinggi dibandingkan pemberian harian. Penelitian ini bertujuan untuk membandingkan hasil pengobatan dan efek samping pengobatan TB-DM fase lanjutan antara pemberian setiap hari dengan intermiten tiga kali seminggu.Metode: penelitian retrospektif menggunakan rekam medik pasien TB-DM dengan desain potong lintang. Sampel penelitian adalah seluruh pasien TB-DM yang sudah memasuki fase lanjutan dan memenuhi kriteria inklusi, yaitu pasien TB-DM tanpa HIV, tanpa gangguan fungsi ginjal atau hati, berusia ≥18 tahun yang mendapat pengobatan TB yang diberikan setiap hari dan tiga kali seminggu di RSUP Persahabatan periode 1 januari 2015-31 desember 2018.Hasil: 64 subyek pada kelompok pengobatan setiap hari dan 69 subyek pada kelompok pengobatan intermiten tiga kali seminggu memenuhi kriteria inklusi. Tidak didapatkan perbedaan antara kelompok pengobatan setiap hari dengan intermiten tiga kali seminggu dalam hal kesembuhan (41,4% vs 44,2%, p=0,814, IP=1,122; IK95%:0,432-2,909), pengobatan lengkap (45,7% vs 50%, p=1,0, IP=1,188; IK95%: 0,430-3,282), gagal (3,4% vs 2,3%, p=0,888, IP=0,667; IK95%: 0,040-11,104), dan putus obat (54,7% vs 49,3%, p=0,533, IP=0,805; IK95%:0,407-1,592). Hanya 1 subyek (3,1%) yang mengalami kekambuhan pada kelompok pengobatan intermiten (p=1,0, IP=0,910; IK95%: 0,910-1,031). Satu subyek (1,6%) pada kelompok pengobatan setiap hari dan 9 subyek (13%) pada kelompok intermiten mengeluhkan efek samping ringan (p=0,018, IP=0,106, IK95%: 0,013-0,861). Sebagian besar pasien pada kedua kelompok menjalani pengobatan selama lebih dari 6 bulan hingga 9 bulan.Kesimpulan: tidak terdapat perbedaan hasil pengobatan antara pemberian obat setiap hari dengan intermiten tiga kali seminggu pada pasien tuberkulosis dengan diabetes melitus. Terdapat perbedaan dalam hal efek samping, yang sifatnya ringan, antara kedua kelompok pengobatan. Sebagian besar pasien pada kedua kelompok menjalani pengobatan selama lebih dari 6 bulan hingga 9 bulan.

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Background and aim: diabetes is the 8th highest risk factor for tuberculosis. Patients with diabetes mellitus (DM) have three times higher risk of active TB. Tuberculosis disturbs glycemic control in DM patients and 69% TB-DM patients would have failed and the risk for relapse is 4 times higher. The optimal treatments strategy for TB-DM patients is not found yet. Management of TB-DM patients is similar with TB without DM. Since 2017, WHO no longer recommends intermittent drug regiment in advanced phase therapy due to the higher risk of treatment failure, TB recurrence, and drug resistance. This study aims to compare treatment outcomes and safety of advanced phase treatment between daily and intermittent treatment in TB-DM patients.Methods: this is a retrospective study with cross sectional design using medical record at Persahabatan Hospital from 1 January 2015 to 31 December 2018. The study sample are all TB-DM patient who have entered the advanced phase that met inclusion criteria, which are TB-DM patients without HIV/ impaired kidney or liver function, aged ≥18 years who had tuberculosis treatment.Results: 64 subjects in daily treatment group and 69 subjects in intermittent group met the inclusion criteria. There are no difference between daily and intermittent group in term of cured (41,4% vs 44,2%, p=0,814, IP=1,122; IK95%:0,432-2,909), completed treatment (45,7% vs 50%, p=1,0, IP=1,188; IK95%: 0,430-3,282), failed (3,4% vs 2,3%, p=0,888, IP=0,667; IK95%: 0,040-11,104), and dropouts (54,7% vs 49,3%, p=0,533, IP=0,805; IK95%:0,407-1,592). Only 1 subject (3,1%) in intermittent group had recurrence (p=1,0, IP=0,910; IK95%: 0,910-1,031). One subject (1,6%) in daily treatment group and 9 subjects (13%) in intermittent group had minor side effects (p=0,018, IP=0,106, IK95%: 0,013-0,861). Most subjects in both groups underwent treatment for more than 6 months up to 9 months.Conclusion: there were no differences in cure rate, complete treatment, failure and dropouts between daily and intermittent treatment in diabetic pulmonary tuberculosis patient. There is difference in side effects, which mostly are mild, between the two group. Most patients in both groups underwent treatment for more than 6 months up to 9 months."