Abstract
BackgroundPatients with type 2 diabetes (DM) have a higher risk of developing pulmonary tuberculosis (PTB); moreover, DM co-morbidity in PTB is associated with poor PTB treatment outcomes. Community based prevalence data on DM and prediabetes (pre-DM) among TB patients is lacking, particularly from the developing world. Therefore we conducted a prospective study to investigate the prevalence of DM and pre-DM and evaluated the risk factors for the presence of DM among newly detected PTB patients in rural areas of China.Methods and FindingsIn a prospective community based study carried out from 2010 to 2012, a representative sample of 6382 newly detected PTB patients from 7 TB clinics in Linyi were tested for DM. A population of 6674 non-TB controls from the same community was similarly tested as well. The prevalence of DM in TB patients (6.3%) was higher than that in non-TB controls (4.7%, p<0.05). PTB patients had a higher odds of DM than non-TB controls (adjusted OR 3.17, 95% CI 1.14–8.84). The prevalence of DM increased with age and was significantly higher in TB patients in the age categories above 30 years (p<0.05). Among TB patients, those with normal weight (BMI 18.5–23.9) had the lowest prevalence of DM (5.8%). Increasing age, family history of DM, positive sputum smear, cavity on chest X-ray and higher yearly income (≥10000 RMB yuan) were positively associated and frequent outdoor activity was negatively associated with DM in PTB patients.ConclusionsThe prevalence of DM in PTB patients was higher than in non-TB controls with a 3 fold higher adjusted odds ratio of having DM. Given the increasing DM prevalence and still high burden of TB in China, this association may represent a new public health challenge concerning the prevention and treatment of both diseases.
Highlights
The association between diabetes mellitus (DM) and tuberculosis (TB) has been recognised for centuries
The patient was diagnosed as smear-positive pulmonary tuberculosis (PTB) if sputum specimens were smear positive; if sputum smears were negative and chest radiograph was compatible with active PTB, the patient was diagnosed as smearnegative PTB after discussion by clinical and radiographic doctors [9]
The details on the total number of eligible PTB patients, those who gave written consent to undergo screening of DM and those included in the final analysis are illustrated in a flow chart (Figure 1)
Summary
The association between diabetes mellitus (DM) and tuberculosis (TB) has been recognised for centuries. The co-morbidity of DM and TB represents a double burden with significant public health implications as recently recognised by several authors [3,4]. In developing countries such as India, China, Bangladesh, Indonesia and Brazil, where TB is still highly endemic [5], the double burden and interaction of DM and TB will be more ominous. Patients with type 2 diabetes (DM) have a higher risk of developing pulmonary tuberculosis (PTB); DM co-morbidity in PTB is associated with poor PTB treatment outcomes.
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