Abstract
Type 2 diabetes mellitus (DM) is commonly associated with pulmonary tuberculosis (TB) and vice versa. Although most individuals with DM and TB pass through intermediate state of pre-diabetes mellitus (PDM) and latent tuberculosis infection (LTBI) respectively, however, data is scant on PDM and LTBI in co-endemic populations to inform recommendations on intervention in those settings. This study aimed to assess the prevalence of PDM and LTBI and determine the susceptibility factors among presumably low- risk adults in a high DM-and TB setting. A cross-sectional study of 352 able-bodied adults was conducted in three communities representative of the southern Nigeria population. Socio-demographic and anthropometric data of the participants were collected using a modified WHO STEPS Wise instrument. A single random blood sample was used to measure glycated hemoglobin (HbA1c) using Cobas c111 Auto-analyzer and interferon-gamma (INF-γ) production with the aid of Quantiferon TB-Gold-In Tube (QFT-GIT) kit. Pre-diabetes was defined as HbA1c between 5.7-6.4% and LTBI as INF- γ positivity (≥0.35 IU/ml). Overall, the prevalence of PDM was 29 (8.2%) (95% CI: 6.4-9.4%) and LTBI 83 (23.6%) (95% CI: 21.6-27.3%), while 9 (2.6%) had dual PDM-LTBI. The urbanites recorded higher PDM 15 (12.8%) (X2=6.340, p=0.022) whereas LTBI was higher among villagers 48 (43.6%) (X2=36.503, p=0.0001). Risk factors associated with PDM and LTBI were: residence status, aging, smoking, familial DM and non-BCG vaccination. Aging was the single most important predictor of PDM (X2=8.469, p=0.007), LTBI (X2=59.541, p=0.001); with aged 50-59 years having four-fold higher risk of PDM-LTBI (OR=4.72, 95% CI=3.25; p=0.0001). These findings indicate that one in twelve and one in four presumably healthy persons screened were found to harbor PDM and LTBI respectively. There is a twin epidemic of PDM and LTBI among southern Nigeria adults. Susceptibility pattern suggests environmental, familial and cumulative life-time risks. ‘Syndemic’ DM and TB in the area is imminent in the absence of timeous intervention.
Highlights
Concurrent type-2 diabetes mellitus (DM) and pulmonary tuberculosis (TB) is one of the most common co-morbid and mortal conditions worldwide
The multi-community sampling from three (3) different and heterogeneous communities has ensured representativeness, enhancing the quality of the data from this work. This multi-centric study of apparently healthy adults from southern Nigeria found a moderate prevalence of intermediate hyperglycemia (PDM) and high rate of Mycobacterium tuberculosis carriage (LTBI) among the adults, some of them even harbored pre-diabetes mellitus (PDM) and latent tuberculosis infection (LTBI) concurrently
The data revealed that the prevalence of PDM among the adults with LTBI was more than twice the rate of those without it
Summary
Concurrent type-2 diabetes mellitus (DM) and pulmonary tuberculosis (TB) is one of the most common co-morbid and mortal conditions worldwide. Available reports indicate that more than 70% of patients with DM live in the low – and Benson Olu Akinshipe et al.: Prevalence and Determinants of Pre-diabetes and Latent Tuberculosis Infection. In the majority of cases, both DM and TB are preceded by asymptomatic latent preliminary stage, pre-diabetes mellitus (PDM) and latent tuberculosis infection (LTBI) respectively. These two conditions can co-exist undetected for many years [7, 8], causing latent irreversible damage to vital body organs [9]. Pre-diabetes and latent tuberculosis infection represent the tip of the iceberg respectively, for diabetes and tuberculosis disease
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