FACTORS ASSOCIATED WITH TYPE 2 DIABETES MELLITUS SCREENING AMONG TUBERCULOSIS PATIENTS IN MBALE REGIONAL REFERRAL HOSPITAL
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2026-09-25
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Abstract
The growing dual burden of Type 2 Diabetes Mellitus (T2DM) and Tuberculosis (TB) poses a significant public health challenge, particularly in low- and middle-income countries. T2DM increases the risk of developing active TB and is associated with poorer TB treatment outcomes, including delayed sputum conversion, treatment failure, relapse and mortality. Despite national and global recommendations for bidirectional screening, implementation of T2DM screening among TB patients remains suboptimal in many settings, including Uganda, leading to missed diagnoses and poor treatment outcomes. This study aimed to determine the proportion of patients with TB screened for T2DM, assess factors associated with T2DM screening, and explore healthcare worker and health system barriers and facilitators affecting implementation at Mbale Regional Referral Hospital. A sequential explanatory mixed methods design was employed. The quantitative phase used a cross-sectional review of 310 TB patient records selected from an eligible sampling frame of 532 records, while the qualitative phase used key informant interviews with healthcare workers involved in TB and diabetes care. Quantitative data were analysed using descriptive statistics, bivariate tests and multivariable logistic regression, while qualitative data were analysed thematically using the six phases described by Braun and Clarke. Overall, 18.1% (56/310) of patients with TB were screened for T2DM. Among those screened, 44.6% (25/56) had normal blood glucose, 42.9% (24/56) had prediabetes, 8.9% (5/56) were newly identified with T2DM, and 3.6% (2/56) were already known to have T2DM. In the final multivariable model, age 50 years and above and rural residence were independently associated with T2DM screening. Drug resistant TB showed a strong bivariate association with screening but was not estimated as an independent predictor because near universal screening in this group produced quasi complete separation. Qualitative findings identified commodity shortages, weak service integration, workload, documentation burden and selective screening as major barriers, while guidance, training, supervision, routine data use and availability of TB and diabetes services were facilitators. T2DM screening among patients with TB at Mbale Regional Referral Hospital was low and selective rather than routine. The findings indicate important missed opportunities for early detection, including five newly identified T2DM cases among the 56 patients screened. Strengthening screening requires reliable commodities, clearer integration of TB and diabetes services, routine documentation and review of screening indicators, and continuous healthcare worker mentorship.