Abstract
To estimate the incidence of pulmonary tuberculosis (PTB) in Chinese diabetes patients and to evaluate the effect of blood glucose on PTB risk, a retrospective cohort study was built based on the diabetes management system in Shanghai and included 240,692 adults aged 35 or above. Incidences of PTB in all diabetes patients and by subgroups were calculated and compared. Multivariable Cox regression models with restricted cubic splines were used to evaluate the association of fasting plasma glucose (FPG) with the risk of PTB. A total of 439 incident PTB cases were identified in the cohort after an average of 3.83 years of follow-up. The overall PTB incidence rate was 51.3/100,000 in diabetes patients, and annual incidence remained higher than that in general population. The PTB incidence rate of diabetes patients was higher in men than in women (86.2 vs. 22.1 per 100,000) and was highest in patients with body mass index (BMI) < 18.5 kg/m2 (215.2/100,000) or FPG ≥ 10 mmol/L (143.2/100,000). Our results suggest that the risk of tuberculosis may be greater at higher levels of FPG in diabetes patients of normal weight. Specific tuberculosis screening strategies for different characteristic diabetes population should be provided to prevent and control tuberculosis in China.
Highlights
To estimate the incidence of pulmonary tuberculosis (PTB) in Chinese diabetes patients and to evaluate the effect of blood glucose on PTB risk, a retrospective cohort study was built based on the diabetes management system in Shanghai and included 240,692 adults aged 35 or above
The association of TB and type 2 diabetes mellitus (T2DM) has been verified in several studies[5,9,16,25], we noted that population-based cohort studies focusing on the risk of TB incidence among T2DM patients in Shanghai, China, were limited, where the burden of diabetes is soaring year by year
We found that the annual incidence of PTB remained higher than that in general population from 2010 to 2015, and the overall incidence rate was 51.3 per 100,000 person-years
Summary
To estimate the incidence of pulmonary tuberculosis (PTB) in Chinese diabetes patients and to evaluate the effect of blood glucose on PTB risk, a retrospective cohort study was built based on the diabetes management system in Shanghai and included 240,692 adults aged 35 or above. The overall PTB incidence rate was 51.3/100,000 in diabetes patients, and annual incidence remained higher than that in general population. The estimated number of incident TB attributable to T2DM increased from 10% in 2010 to 15% in 2013, globally, and almost 17% of diabetes-associated TB cases occurred in China[8]. Owing to limited medical resources and relatively low incidence rate in Shanghai, it is important to identify risk factors of TB in T2DM patients in order to obtain more beneficial effectiveness
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