Abstract
BackgroundDiabetes is a well-known risk factor for tuberculosis and poorly glycemic control may increase the risk of tuberculosis. We performed a meta-analysis to explore the association of glycemic control in diabetic patients and their tuberculosis prevalence.MethodsWe included observational studies that investigated the prevalence of tuberculosis associated with glycemic control. The markers of glycated hemoglobin A1c (HbA1c) and fasting plasma glucose were used to evaluate the exposure of interest in the study. We searched related articles in PubMed, EMBASE and Web of Science through 14 December 2019. The Newcastle-Ottawa scale was used to assess the risk of bias of included studies.ResultsSeventeen studies (four cohort studies, five case-control studies and eight cross-sectional studies) were included, involving 1,027,074 participants. The meta-analysis found the pooled odds ratio of prevalent tuberculosis increased a 2.05-fold (95%CI: 1.65, 2.55) for the patients with HbA1c ≥7.0% compared to those with HbA1c concentration < 7.0%. Furthermore, we found the mean of HbA1c was higher in the diabetes mellitus with tuberculosis group than the diabetes-only group (P = 0.002). In the sensitivity analysis, the finding remains consistent.ConclusionOur study provides the evidence that poorly controlled diabetes in diabetics may be associated with increased prevalence of tuberculosis. More efforts should focus on screening tuberculosis in uncontrolled diabetes.
Highlights
Diabetes is a well-known risk factor for tuberculosis and poorly glycemic control may increase the risk of tuberculosis
One explanation for these results is that dysglycemia in diabetic patients may impair their innate immune system that seems to provide a favorable environment for acute intracellular bacterial infections in diabetic patients [6, 7]
We examined the relationship between hemoglobin A1c (HbA1c) and the prevalence of pulmonary TB in diabetes mellitus (DM) patients: grouped by HbA1c ≥ 7% and HbA1c < 7%; HbA1c was taken as a continuous variable to observe the difference of its mean value between TB-DM group and DM only group; we focused on the fasting blood glucose index, and explored the mean difference between the two groups (TB-DM group and simple DM group)
Summary
Diabetes is a well-known risk factor for tuberculosis and poorly glycemic control may increase the risk of tuberculosis. Besides HIV infection, poverty, undernutrition, and smoking, diabetes mellitus (DM) has received recent recognition as a risk factor for TB [2]. In the two nationwide population-based studies, there was a higher underlying prevalence of tuberculosis infection at baseline in diabetics patients compared to the healthy population [4, 5]. One explanation for these results is that dysglycemia in diabetic patients may impair their innate immune system that seems to provide a favorable environment for acute intracellular bacterial infections in diabetic patients [6, 7].
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