Abstract
BackgroundVitamin D could be a mediator in the association between tuberculosis (TB) and diabetes mellitus (DM). A large scale multi-center study confirmed that TB patients with DM had significantly lower serum vitamin D level compared with those without DM and reported that DM was a strong independent risk factor for vitamin D deficiency.ObjectivesThis study was undertaken to determine amongst patients with both TB and DM living in different economically defined areas in China: i) their baseline characteristics, ii) their vitamin D status and iii) whether certain baseline characteristics were associated with vitamin D deficiency.MethodsIn DM-TB patients consecutively attending seven clinics or hospitals, we measured 25 hydroxycholecalciferol at the time of registration using electrochemiluminescence in a COBASE 601 Roche analyser by chemiluminescence immunoassay. Data analysis was performed using chi square test and multivariate logistic regression.ResultsThere were 178 DM-TB patients that included 50 from economically well-developed areas, 103 from better-off areas and 25 from a poverty area. Median vitamin D levels in well-developed, better-off and poverty areas were 11.5ng/ml, 12.2ng/ml and 11.5ng/ml respectively. Amongst all patients, 149 (84%) had vitamin D deficiency—91 (51%) with vitamin D deficiency (10–19.9 ng/ml) and 58 (33%) with severe deficiency (< 10 ng/ml). There was a significantly higher proportion with vitamin D deficiency in the poverty area. The adjusted odds of vitamin D deficiency (25-(OH)D3 <20 ng/ml) were significantly higher in those with longer history of DM (P = 0.038) and with HbA1c≥10% (P = 0.003).ConclusionOver 80% of TB patients with DM in China were vitamin D deficient, with risk factors being residence in a poverty area, a long duration of DM and uncontrolled DM. TB programme managers and clinicians need to pay more attention to the vitamin D status of their patients.
Highlights
Diabetes mellitus (DM) is a chronic condition that occurs when the body cannot produce or effectively utilize insulin, which results in increased levels of glucose in the blood stream causing metabolic disorders of many organs over time [1]
Recent research has found that persons with type 2 DM with low serum vitamin D levels have impaired monocyte function and reduced capacity to restrict the intracellular growth of Mycobacterium tuberculosis (MTB), and this may be one of the factors linking DM to an increased risk of TB [9]
All TB patients were diagnosed, registered, and managed according to the guidelines of the China National TB Control Program; which is in accordance with those recommended by the World Health Organization (WHO) [15,16]
Summary
Diabetes mellitus (DM) is a chronic condition that occurs when the body cannot produce or effectively utilize insulin, which results in increased levels of glucose in the blood stream (hyperglycaemia) causing metabolic disorders of many organs over time [1]. DM is associated with several co-morbidities, one of which is a three times higher risk of developing tuberculosis (TB) compared with the general population [2,3]. Vitamin D plays a key role in human innate and adaptive immunity [5], and assists mononuclear phagocytes to suppress the intracellular growth of Mycobacterium tuberculosis (MTB) after initial infection [7,8]. Recent research has found that persons with type 2 DM with low serum vitamin D levels have impaired monocyte function and reduced capacity to restrict the intracellular growth of MTB, and this may be one of the factors linking DM to an increased risk of TB [9]. A large scale multi-center study confirmed that TB patients with DM had significantly lower serum vitamin D level compared with those without DM and reported that DM was a strong independent risk factor for vitamin D deficiency
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
