Imaging features of primary type 2 diabetes patients with RR/MDR tuberculosis

To the best of our knowledge, imaging features of primary type 2 diabetes mellitus patients with rifampicin-resistant/multidrug-resistant tuberculosis (T2DM RR/MDR-TB) have not been reported in the literature to date. Hence this study investigated the imaging features of primary T2DM RR/MDR-TB patients.

The clinical data and pulmonary CT findings of 87 primary T2DM RR/MDR-TB patients, 98 primary non-type 2 diabetes mellitus patients with rifampicin-resistant/multidrug-resistant tuberculosis (NT2DM RR/MDR-TB), 86 primary type 2 diabetes patients with drug-susceptible tuberculosis (T2DM DS-TB), and 93 primary pure drug-susceptible TB (DS-TB) patients without T2DM or RR/MDR-TB who were treated at Dalian Public Health Clinical Center from 2018 to 2023 were collected, and the clinical features and imaging differences among the four groups were compared using the chi-square test for categorical variables and the Kruskal-Wallis H test for ordinal or non-normally distributed continuous variables.

According to the results, among the four groups of patients, the NT2DM RR/MDR-TB patients were the youngest (p = 6.27e-10). Compared with non-diabetic patients, both T2DM RR/MDR-TB patients and T2DM DS-TB patients had a greater proportion of males (p = 1.28e-8) and a greater body mass index (BMI) (p = 6.01e-9) but lower albumin levels (p = 0.009). T2DM RR/MDR-TB patients presented the highest rates of smoking (p = 0.006) and alcohol abuse (p = 0.000281). In terms of imaging features, multinomial logistic regression analysis revealed that large nodules (p = 0.000239), patchy opacities (p = 0.004), non-calcified enlargement of mediastinal lymph nodes (p = 0.005), and especially multiple cavities (≥3 cavities) (p = 2.21e-8) were high-risk factors for T2DM in RR/MDR-TB patients (p < 0.05). As the glycated hemoglobin (HbA1c) levels increased, the incidence of large nodules (p = 0.029), multiple cavities (p = 0.000030), pleural effusion (p = 0.045), and non-calcified enlargement of mediastinal lymph nodes (p = 0.001) also increased in the T2DM RR/MDR-TB patients; conversely, the absence of cavities ("0" cavities) (p = 0.000009) decreased with increasing HbA1c levels.

Imaging features, such as large solid nodules, patchy opacities, and particularly multiple cavities, are high-risk factors for T2DM in RR/MDR-TB patients. The presence of multiple cavities and extrapulmonary involvement increases with increasing blood glucose levels. Therefore, controlling blood glucose levels may reduce the risk and severity of T2DM RR/MDR-TB.