Outcomes of lower extremities tuberculous wounds in diabetic patients in Eastern Sudan-Kassala: a prospective observational study

The prevalence of both diabetes mellitus (DM) and tuberculosis (TB) is increasing. DM is a risk factor for TB, while TB will adversely affect DM's treatment. The combined presentation is more prevalent in TB-endemic areas and among low socioeconomic populations.

This is a longitudinal prospective observational study conducted at Kassala State in Sudan between March 2012 and March 2022, including diabetic patients with tuberculous infected ulcers. The outcome measures were wound healing, response to anti-Tuberculous drugs, and final treatment outcome.

120 patients participated in the study; the majority were males, 66.7%, living in rural areas 75.0%, 66.7% had wounds in the foot, and 60.8% had their wounds healed in less than 60 days. The mean duration of diabetes was 14 years. Younger age, male gender, urban residence place, shorter disease duration, shorter hospital stay, and proximal wound site were associated with faster wound healing, with a P value < 0.05. A better response to anti-TB drugs was observed with the proximal site of the wound, negative acid-alcohol fast bacilli (AAFB) test result, higher erythrocytes sedimentation rate (ESR) levels, and absence or less severe peripheral arterial disease (PAD), and low glycosylated hemoglobin (HbA1c) level with P values < 0.05. For the final treatment outcome, rural residence, distal site of the wound, presence and high severity of PAD, and high HbA1c level were associated with poorer outcomes with P values < 0.05.

Our study identified several factors associated with shorter wound healing durations, including younger age, male gender, urban residence and other factors. For the response to anti-TB drugs, a proximal wound site, and other factors were significant positive predictors. Conversely, rural residence, foot wounds, severe PAD, and high HbA1c levels negatively impacted the final treatment outcome. These findings highlight the need for further multicentric studies to validate and refine our understanding of these factors such as effect of PAD and tight glycemic control and their impact on the patients’ response and treatment outcome. Additionally, the limitations of this study such as the possibility of selection bias, sample size and the regional focus should be addressed and avoided in future studies.