Prevalence and Risk Factors of Latent Tuberculosis Infection (LTBI) in Patients with Type 2 Diabetes Mellitus (T2DM).

Phan Ai Ping,Md Asiful Islam,Rosediani Muhamad,Harmy Mohamed Yusoff,Wan Mohamad Zahiruddin Wan Mohamad,Lili Husniati Yaacob,Rosnani Zakaria

doi:10.3390/ijerph18010305

Abstract

Type 2 diabetes mellitus (T2DM) and tuberculosis (TB) together impose a high disease burden in terms of both mortality and health economics worldwide. The objective of this study was to estimate the prevalence and risk factors of latent TB infection (LTBI) in patients with T2DM in Malaysia. A cross-sectional study was performed, and adult T2DM patients (n = 299) were included. Simple and multiple logistic regression analyses were performed to identify the LTBI-associated risk factors in patients with T2DM. Multiple logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CIs) between T2DM and LTBI and was adjusted for potential confounders. The prevalence of LTBI in patients with T2DM was 11.4% (95% CI: 8.0–15.0%). There was no significant difference in the socio-demographic characteristics between LTBI and non-LTBI subjects. No significant difference in the smoking status, the duration of smoking, and the duration of T2DM, HbA1c, or treatments was observed. Interestingly, a higher level of education was observed to be associated with a lower prevalence of LTBI in T2DM patients (aOR: 0.08, 95% CI: 0.01–0.70, p = 0.02). Although the prevalence of LTBI in T2DM was low, it is important to screen for it in T2DM patients due to the risk of developing severe active TB.

Highlights

In 2018, 10 million people developed active TB [non-human immunodeficiency virus (HIV) TB], and 1.2 million of them died [1]
There was no significant difference on the educational levels, occupation or monthly income between Latent tuberculosis infection (LTBI) and nonLTBI subjects
There were no significant differences for duration of type 2 diabetes mellitus (T2DM), smoking status, duration of smoking, HbA1c result, previous Bacillus Calmette–Guérin (BCG) vaccination, and treatments between the patients with LTBI and non-LTBI (Table 2)

Summary

Introduction

In 2018, 10 million people developed active TB [non-human immunodeficiency virus (HIV) TB], and 1.2 million of them died [1]. It was estimated that globally, approximately 1.7 billion people were latently infected with Mycobacterium tuberculosis in the year 2014 [4]. The exact mechanism of the development of LTBI is still unclear; there is growing evidence suggesting that the risk of reactivation of LTBI into an active TB is greater in some noncommunicable diseases which affect the function of the immune system. T2DM is still considered as a steadily increasing epidemic global disease burden, with 382 million worldwide sufferers in 2014 and a projected 592 million sufferers by the year Even though the rate of latent TB reactivation is around 10% [5,6], the risk of reactivation is many folds higher in immunosuppressed patients and patients with type 2 diabetes mellitus (T2DM) [7,8,9].

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Discussion

Conclusion