Does enhanced diabetes management reduce the risk and improve the outcome of tuberculosis?

SETTING: The Bureau of National Health Insurance (NHI) has implemented a pay-for-performance (p4p) programme for diabetes mellitus (DM) in Taiwan. OBJECTIVE: To investigate whether patients with DM enrolled in the p4p programme (DM-p4p) are less likely to develop tuberculosis (TB) and whether they have a better outcome than patients with DM not enrolled in the p4p programme (DM-non-p4p) if they do develop TB. DESIGN: A random sample of 79 471 DM-p4p, 100 000 DM-non-p4p and 100 000 non-diabetic patients (non DM) was obtained from the 2008-2009 NHI database, and the patients were matched with the National TB Registry to determine whether they had developed TB by the end of 2010. RESULTS: The average annual incidence of TB was respectively 259.9 (95%CI 230.2-293.4), 137.5 (95%CI 116.4-162.5) and 74.1 (95%CI 59.0-93.0) per 100 000 population among DM-non-p4p, DM-p4p and non-DM patients. The relative risk of death over treatment success was 1.79 (95%CI 1.05-3.04) among DM-non-p4p and 1.69 (95 % CI 0.84-3.40) among non DM patients, relative to DM-p4p patients. CONCLUSIONS: Enhanced case management of DM reduced risk and improved outcomes of TB among patients with DM.