Abstract
BackgroundMalnutrition and diabetes are risk factors for active tuberculosis (TB), possible risk factors for latent TB infection (LTBI), and may interact to alter their effect on these outcomes. Studies to date have not investigated this interaction.MethodsWe enrolled 919 newly diagnosed active TB patients and 1113 household contacts at Primary Health Centres in Puducherry and Tamil Nadu, India from 2014 to 2018. In cross-sectional analyses, we used generalized estimating equations to measure additive and multiplicative interaction of body mass index (BMI) and diabetes on two outcomes, active TB and LTBI.ResultsAmong overweight or obese adults, active TB prevalence was 12-times higher in diabetic compared to non-diabetic participants, 2.5-times higher among normal weight adults, and no different among underweight adults (P for interaction < 0.0001). Diabetes was associated with 50 additional active TB cases per 100 overweight or obese participants, 56 per 100 normal weight participants, and 17 per 100 underweight participants (P for interaction < 0.0001). Across BMI categories, screening 2.3–3.8 active TB patients yielded one hyperglycemic patient. LTBI prevalence did not differ by diabetes and BMI*diabetes interaction was not significant.ConclusionsBMI and diabetes are associated with newly diagnosed active TB, but not LTBI. Diabetes conferred the greatest risk of active TB in overweight and obese adults whereas the burden of active TB associated with diabetes was similar for normal and overweight or obese adults. Hyperglycemia was common among all active TB patients. These findings highlight the importance of bi-directional diabetes-active TB screening in India.
Highlights
Malnutrition and diabetes are risk factors for active tuberculosis (TB), possible risk factors for latent TB infection (LTBI), and may interact to alter their effect on these outcomes
365 (18%) participants reported a prior diabetes diagnosis, and diabetes was more common among active TB patients than their household contacts (32% versus 6%)
Of the 344 diabetic participants who received random blood glucose (RBG) testing, 72% had an RBG ≥200 mg/dL whereas 66/1155 (6%) of those who had not been diagnosed with diabetes had RBG ≥200 mg/dL
Summary
Malnutrition and diabetes are risk factors for active tuberculosis (TB), possible risk factors for latent TB infection (LTBI), and may interact to alter their effect on these outcomes. Among 2.7 million incident TB cases in India, 15% may be attributable to diabetes and 32–62% may be attributable to malnutrition [1, 12, 13]. These diseases are associated with personal catastrophic health expenditures in vulnerable populations, which may be partially mitigated through proactive screening practices and preventative care [14]. Given the challenge of providing quality care to this large and growing diabetic patient population, identifying those most likely to have active TB could help to focus limited resources
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