Abstract
BackgroundDiabetes and TB are associated, and diabetes is increasingly common in low-income countries where tuberculosis (TB) is highly endemic. However, the role of diabetes for TB has not been assessed in populations where HIV is prevalent.MethodsA case-control study was conducted in an urban population in Tanzania among culture-confirmed pulmonary TB patients and non-TB neighbourhood controls. Participants were tested for diabetes according to WHO guidelines and serum concentrations of acute phase reactants were measured. The association between diabetes and TB, and the role of HIV as an effect modifier, were examined using logistic regression. Since blood glucose levels increase during the acute phase response, we adjusted for elevated serum acute phase reactants.ResultsAmong 803 cases and 350 controls the mean (SD) age was 34.8 (11.9) and 33.8 (12.0) years, and the prevalence of diabetes was 16.7% (95% CI: 14.2; 19.4) and 9.4% (6.6; 13.0), respectively. Diabetes was associated with TB (OR 2.2, 95% CI: 1.5; 3.4, p<0.001). However, the association depended on HIV status (interaction, p = 0.01) due to a stronger association among HIV uninfected (OR 4.2, 95% CI: 1.5; 11.6, p = 0.01) compared to HIV infected (OR 0.1, 95% CI: 0.01; 1.8, p = 0.13) after adjusting for age, sex, demographic factors and elevated serum acute phase reactants.ConclusionDiabetes is a risk factor for TB in HIV uninfected, whereas the association in HIV infected patients needs further study. The increasing diabetes prevalence may be a threat to TB control.
Highlights
The number of people living with type 2 diabetes mellitus is projected to double between 2000 and 2030, based on increasing life-expectancy and urbanization [1]
Mean body mass index (BMI) was lower among cases, and the proportion with elevated serum acute phase reactants was higher
This study shows that diabetes is a strong risk factor for pulmonary TB
Summary
The number of people living with type 2 diabetes mellitus (diabetes) is projected to double between 2000 and 2030, based on increasing life-expectancy and urbanization [1]. The mechanisms are not clear, but may be through impaired cell-mediated immunity [3] as well as neutrophil function [9,10,11] Such effects are likely to be detrimental in low-income countries, where diabetes usually remains undiagnosed or untreated due to weak health systems [12], and may occur in individuals with high exposure to tuberculosis (TB) and other infectious diseases. Studies primarily from middle and high-income countries suggest that diabetes is associated with increased risk of TB. Any effect of diabetes on risk of TB and other infections is of greater concern in low-income countries. The effect of diabetes on risk of TB has not been assessed in a population with a high prevalence of HIV, a known strong competing risk factor. The role of diabetes for TB has not been assessed in populations where HIV is prevalent
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