Diabetes Mellitus Tuberculosis Research Articles

NAVIGATING BARRIERS: THE NEED FOR INTEGRATED HEALTH INFORMATION SYSTEM FOR TUBERCULOSIS-DIABETES CO-SCREENING

Background: Tuberculosis-diabetes mellitus (TB-DM) is a co-epidemic condition representing a double burden for high TB burden countries like Indonesia. Private primary care (PPC) in Indonesia was newly reintroduced to the TB program. Aims: This study explores the challenges PPC healthcare workers (HCWs) face in implementing TB-DM bi-directional screening and strategies to improve it. Methods: An explorative qualitative method was used by conducting two-round focus group discussions (FGDs) with HCWs (n=15) from five private clinics in Yogyakarta Special Region Province Indonesia and triangulated with 10 DM patients and the TB program manager from the provincial health office. The data were audio recorded, transcribed verbatim, and subjected to thematic analysis. Results: HCWs face complex barriers in TB-DM co-screening implementation from patients, HCWs, and health system aspects. An integrated system to remind, support decision-making, report, reduce documentation duplication, monitor, and evaluate co-screening implementation emerged as a potential strategy, although some challenges to deploy. Conclusion: Albeit HIS is promising in enhancing integrated TB-DM screening and management, a comprehensive approach and multisector roles are still needed to overcome impediments to TB-DM bidirectional screening in PPCs. Keywords: diabetes mellitus, health information system, screening, tuberculosis

A cross-sectional observational study to assess socio-demographic factors in newly diagnosed TB DM comorbidity

Background Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is one of the rising public health problems. There is growing evidence that DM is an important risk factor for TB. This study was carried out to know the prevalence of DM among newly detected sputum positive pulmonary TB patients registered in District Tuberculosis Centre and to assess the risk factors of DM among TB patients. Methods In a cross-sectional study, newly detected sputum positive pulmonary TB patients were screened for DM (those having symptoms of DM). Furthermore, they were diagnosed by detecting blood glucose levels (≥200 mg/dL). Mean, standard deviation (SD), Chi-squared and Fisher-Freeman-Halton exact tests were used to determine the significant associations. P-values less than 0.05 were considered to be statistically significant. Results A total of 215 TB patients were included in this study. The prevalence of DM among TB patients was found to be 23.7% (2.8% known and 97.8% new cases). Significant associations were found between age (>46 years old), educational status, smoking habits, alcohol consumption, physical activity, presence of DM symptoms and family history of DM. Conclusions Routine screening for DM is mandatory due to its increasing prevalence, which may help in early diagnosis and to reduce complications by proper management that in turn helps in the successful outcome of TB treatment.

The effect of diabetes mellitus on tuberculosis in eastern China: A decision-tree analysis based on a real-world study.

The public health system faces major challenges due to the double burden of diabetes mellitus (DM) and tuberculosis (TB) in China. We aimed to investigate the prevalence and impact of diabetes on patients with TB. Stratified cluster sampling was used to select 13 counties as study sites in the Zhejiang province. Patients who visited designated TB hospitals in these areas participated in this study between 1 January 2017 and 28 February 2019. Multiple logistic regression models were performed to investigate the association between DM and bacteriological and imaging results. A decision tree was used to predict the bacteriology and imaging results under the influence of DM. Of 5920 patients with newly diagnosed pulmonary tuberculosis, 643 (12.16%) had DM. Patients with pulmonary TB and DM were more likely to have pulmonary cavities (adjusted odds ratio [aOR], 2.81; 95% confidence intervals [95% CI]: 2.35-3.37) and higher rates of positive bacteriological tests (aOR, 2.32; 95% CI:1.87-2.87). Decision-tree analysis showed similar results. Concurrence of DM and pulmonary TB makes patients more likely to have positive bacteriological results and pulmonary cavities. Therefore, appropriate measures are necessary to promptly identify and manage patients with TB and DM.

Health Care Providers' Knowledge of Tuberculosis and Diabetes Mellitus Comorbidity in Lubumbashi, Democratic Republic of the Congo (DRC).

Tuberculosis-Diabetes mellitus (TB-DM) co-morbidity is a growing scourge in the world. The new approaches and interventions for TB control implemented by the Tuberculosis National Control Program (TNCP) in DRC require the involvement of health care providers for their success. The objective of this study is to assess the knowledge of health care provider on different aspects of the management of TB-DM co-morbidity and to compare this knowledge according to the health care system, the type of providers and the number of years of experience. Cross-sectional and analytic study was conducted in 11 health care facilities in the Lubumbashi Health District, selected by reasoned choice, and an electronic questionnaire was administered to health care providers. These providers were interviewed on the different aspects of the management of the TB-DM comorbidity. The data were presented and compared in relation to knowledge about TB, DM, and TB-DM comorbidity. A total of 113 providers were interviewed, predominantly males and physicians. Questions related to knowledge about DM were better answered. Doctors compared to paramedics; tertiary-level providers compared to secondary-level providers had better responses to the different questions. There is a statistically significant correlation between the level of knowledge of TB, DM and the type of health care provider, the number of years of experience. The present study shows that there are gaps in the knowledge of our health care providers and community members on the recommendations of the DRC TB guidelines (Programme AntiTuberculeux Intégré 5: PATI 5) in general and on the management of TB-DM. It is therefore important and necessary to put in place strategies to improve this level of knowledge, which will focus on the extension of the guidelines, the awareness and the training of the stakeholders involved in the control.

INTENSIVE CASE FINDINGS OF TUBERCULOSIS AND DIABETES MELLITUS IN PATIENTS ATTENDING TERTIARY CARE HOSPITAL IN TRIBAL AREA IN GUJARAT

Tuberculosis (TB) in association with Diabetes Mellitus (DM), TB may get worsen as increased relapse rates, delayed sputum culture conversion, increase in the case fatality rates etc. Conversely, TB may increase the incidence of DM, and worsen glycaemic control in diabetes patients. A cross-sectional cohort study conducted at Medicine and Pulmonology department of ZMCH DAHOD for a period of nine months in June 2020- February 2021. All TB patients were screened for DM and vice versa. All TB patients were followed-up for treatment outcome of TB and all DM patients were followed-up for glycaemic control. Relative risk was calculated using incidence of outcome or control of disease in TB with DM patients to TB patients and DM with TB patients to DM patients. Of 256 TB patients, 38 (14.8%) were TB with DM cases. All 256 patients were followed-up for TB treatment outcome, 100% TB patients without DM had recovery, whereas 97.3% TB patients with DM had recovery after two months of therapy. Relative risk of DM on TB outcome was 0.97. Of 256 DM patients screened, 9 (3.5%) had been newly diagnosed with TB. All 256 people were followed-up for impact on glycaemic control. Relative risk of TB on glycemic control was 1.87. Bidirectional screening would potentially improve care and prevention of TB and DM.

Impact of diabetes mellitus on immunity to latent tuberculosis infection.

Tuberculosis (TB) is an infectious disease that poses a major health threat and is one of the leading causes of death worldwide. Following exposure to Mycobacterium tuberculosis (M.tb) bacilli, hosts who fail to clear M.tb end up in a state of latent tuberculosis infection (LTBI), in which the bacteria are contained but not eliminated. Type 2 diabetes mellitus (DM) is a noncommunicable disease that can weaken host immunity and lead to increased susceptibility to various infectious diseases. Despite numerous studies on the relationship between DM and active TB, data on the association between DM and LTBI remains limited. Immunological data suggest that LTBI in the presence of DM leads to an impaired production of protective cytokines and poly-functional T cell responses, accounting for a potential immunological mechanism that could leads to an increased risk of active TB. This review highlights the salient features of the immunological underpinnings influencing the interaction between TB and DM in humans.

A case report on Subacute small Intestinal obstruction secondary to malignant prehepatic flex

In patients with distributed stomach and pelvic cancers, acute and subacute digestive obstruction is a common occurrence. MBO (dangerous gut check) is predicted to occur in the year 1028. ovarian malignancies account for 5.542 percent of colorectal illnesses and 4% of colorectal cancers. In general, it is estimated to occur in 2% of all patients with a cutting-edge threat. It addresses a pattern of recurrence in some patients and a progression of illness in others. As a result, a show with an entrail check has a significant impact on both patients and their families. This audit depicts the current MBO administration, as well as the clinical, interventional, and careful approaches that are used in combination to improve outcomes in these difficult patients.Case presentation: She is, a 50-year-old Female admitted to rural hospital with the objection of torment in mid-region, Nausea, and regurgitating seance 2 days. The patient has no set of experiences of Hypertension and Diabetes Mellitus Tuberculosis and asthma, Patient was cognizant and situated, All scheduled examination was finished. Patient colonoscopy shows climbing colon friable, lumen impeding mass, and various biopsies taken from the mass. Impression Carcinoma climbing colon. Decisions: A 50-year-old female patient conceded to the emergency clinic with the main grievance of torment in mid-region, Nausea, and heaving seen 2 days. After all examination patient was analyzed as an instance of Subacute little Intestinal obstacle auxiliary to harmful prehepatic flex. Presently she is going to be under treatment. Presently tolerant guess is better compared to past and counsel the patient for the ordinary multi-day follow up.

Chronic hyperglycemia drives alterations in macrophage effector function in pulmonary tuberculosis.

Diabetes mellitus (DM) alters immune responses and given the rising prevalence of DM in tuberculosis (TB) endemic countries; hyperglycemia can be a potential risk factor for active TB development. However, the impact of hyperglycemia on TB-specific innate immune response in terms of macrophage functions remains poorly addressed. We assessed macrophage effector functions in uncontrolled DM patients with or without TB infection (PTB+DM and DM), non-diabetic TB patients (PTB), and non-diabetic-uninfected controls. Phagocytic capacity against BCG and surface expression of different pattern recognition receptors (PRRs) (CD11b, CD14, CD206, MARCO, and TLR-2) were measured via flow cytometry. Effector molecules (ROS and NO) required for bacterial killing were assessed via DCFDA and Griess reaction respectively. A systematic dysregulation in phagocytic capacity with concurrent alterations in the expression pattern of key PRRs (CD11b, MARCO, and CD206) was observed in PTB+DM. These altered PRR expressions were associated with decreased phagocytic capacity of macrophages. Similarly, ROS was aberrantly higher while NO was lower in PTB+DM. These altered macrophage functions were positively correlated with increasing disease severity. Our results highlight several key patterns of immune dysregulation against TB infection under hyperglycemic conditions and highlight a negative impact of hyperglycemia with etiology and progression of TB.

A cross-sectional observational study to assess socio-demographic factors in newly diagnosed TB DM comorbidity

Background: Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is one of the rising public health problems. There is growing evidence that DM is an important risk factor for TB. This study was carried out to know the prevalence of DM among newly detected sputum positive pulmonary TB patients registered in District Tuberculosis Centre and to assess the risk factors of DM among TB patients. Methods: In a cross-sectional study, newly detected sputum positive pulmonary TB patients were screened for DM (those having symptoms of DM). Furthermore, they were diagnosed by detecting blood glucose levels (≥200 mg/dL). Mean, standard deviation (SD), Chi-squared and Fisher-Freeman-Halton exact tests were used to determine the significant associations. P-values less than 0.05 were considered to be statistically significant. Results: A total of 215 TB patients were included in this study. The prevalence of DM among TB patients was found to be 23.7% (2.8% known and 97.8% new cases). Significant associations were found between age (>46 years old), educational status, smoking habits, alcohol consumption, physical activity, presence of DM symptoms and family history of DM. Conclusions: Routine screening for DM is mandatory due to its increasing prevalence, which may help in early diagnosis and to reduce complications by proper management that in turn helps in the successful outcome of TB treatment.

A cross-sectional observational study to assess socio-demographic factors in newly diagnosed TB DM comorbidity.

Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is one of the rising public health problems. There is growing evidence that DM is an important risk factor for TB. This study was carried out to know the prevalence of DM among newly detected sputum positive pulmonary TB patients registered in District Tuberculosis Centre and to assess the risk factors of DM among TB patients. In a cross-sectional study, newly detected sputum positive pulmonary TB patients were screened for DM (those having symptoms of DM). Furthermore, they were diagnosed by detecting blood glucose levels (≥200 mg/dL). Mean, standard deviation (SD), Chi-squared and Fisher-Freeman-Halton exact tests were used to determine the significant associations. P-values less than 0.05 were considered to be statistically significant. A total of 215 TB patients were included in this study. The prevalence of DM among TB patients was found to be 23.7% (2.8% known and 97.8% new cases). Significant associations were found between age (>46 years old), educational status, smoking habits, alcohol consumption, physical activity, presence of DM symptoms and family history of DM. Routine screening for DM is mandatory due to its increasing prevalence, which may help in early diagnosis and to reduce complications by proper management that in turn helps in the successful outcome of TB treatment.

Integrated Management of Diabetes and Tuberculosis in Rural India - Results From a Pilot Study.

IntroductionThe World Health Organization and International Union against Tuberculosis (TB) recommends screening patients with TB for Diabetes Mellitus (DM) at the initiation of treatment. There are few pilot studies which screen TB patients for DM, but none of them have documented the feasibility of managing TB patients with DM in the Indian healthcare setting. Operational research is needed to determine the best way to manage individuals with both conditions. This pilot study aimed to develop, and field test an integrated, multidisciplinary program addressing the management of individuals with TB and DM and other associated chronic conditions in the Indian primary healthcare setting.MethodsThis pilot study used a randomized controlled trial design with mixed-methods evaluation and was conducted in Guntur district of Andhra Pradesh, a southern state of India. All the 120 patients newly diagnosed with TB from 10 participating villages were screened for DM and associated cardiovascular risk factors. Non-physician health workers were trained to follow-up patients for a period of 8 months to encourage treatment adherence, monitor treatment response including blood glucose levels and provide lifestyle advice.ResultsThe intervention was well-accepted by the providers and patients. However, there were no statistically significant variations observed for mean blood glucose levels (mean [SD]: 5.3 [−23.3 to 33.8]) of patients for both intervention and control group participants in this feasibility study. Awareness about diabetes and tuberculosis comorbidity and cardiovascular risk increased among the non-physician health workers in the intervention arm of the study.DiscussionThe co-management of TB-DM is acceptable to both the health providers and patients. With appropriate training, availability of infrastructure and planned intervention implementation, it is feasible to co-manage TB-DM within the existing primary health care system in India.

Diabetes mellitus and its associated factors among patients with tuberculosis attending directly observed treatment centres in Oyo State, Nigeria: a cross-sectional evaluation

ObjectiveDiabetes mellitus (DM) and tuberculosis (TB) comorbidity is evolving into an emerging epidemic globally. In Nigeria, a high burden of both diseases, respectively, exists with limited information on tuberculosis-diabetes mellitus...

Tuberculosis risk among people with diabetes mellitus in Sub-Saharan Africa: A systematic review.

ObjectivesPeople with diabetes mellitus (DM) have a higher tuberculosis (TB) risk, but the evidence from sub‐Saharan Africa (SSA) was scarce until recently and not included in earlier global summaries. Therefore, this systematic review aims to determine the risk of active TB disease among people with DM in SSA and whether HIV alters this association.MethodsMedline, Embase, CINAHL, Web of Science, Global Health and African Index Medicus were searched between January 1980 and February 2021. Cohort, case‐control and cross‐sectional studies from SSA, which assessed the association between DM and active TB, were included if adjusted for age. Two researchers independently assessed titles, abstracts, full texts, extracted data and assessed the risk of bias. Estimates for the association between DM and TB were summarised using a random effects meta‐analysis. PROSPERO: CRD42021241743.ResultsNine eligible studies were identified, which reported on 110,905 people from 5 countries. Individual study odds ratios (OR) of the TB–DM association ranged from 0.88 (95% CI 0.17–4.58) to 10.7 (95% CI 4.5–26). The pooled OR was 2.77 (95% CI 1.90–4.05). High heterogeneity was reduced in sensitivity analysis (from I 2 = 57% to I 2 = 6.9%), by excluding one study which ascertained DM by HbA1c. Risk of bias varied widely between studies, especially concerning the way in which DM status was determined.ConclusionsThere is a strong positive association between DM and active TB in SSA. More research is needed to determine whether HIV, a key risk factor for TB in SSA, modifies this relationship.

Gradient association between pulmonary tuberculosis and diabetes mellitus among households with a tuberculosis case: a contact tracing-based study

Pulmonary tuberculosis (PTB) and diabetes mellitus (DM) remain high morbidity and mortality, especially when they are comorbid with each other. Screening for diabetes mellitus in tuberculosis is essential as the incidence and mortality of DM in the population with PTB are higher than in the general people. We aimed to examine the gradient association of tuberculosis on developing DM, the additional yield and the number needed to screen (NNS) to find a new diabetes case. A cross-sectional study was conducted on 801 tuberculosis cases and 972 household contacts in Guizhou, China, from April 2019 to October 2020. After screening for PTB among contacts, all participants were screened for DM and interviewed. Kendall’s tau-b test and proportional odds logistic regression analysis were applied to identify the gradient associations. Among the 1773 subjects, the additional yield of screening was 21.8%. The NNSs of the non-PTB group, the sputum-culture negative and positive groups were 50, 60 and 113, respectively. The gradient incremental establishment of DM and PTB were positively correlated. The general trend on the gradient of DM significantly increased with the gradient increase of PTB. Age 35 years and over, excessive edible oil intake and DM family history were identified as significant predictors of diabetes. Integrated screening for DM targeted to different gradients of PTB combined with associated factors is necessitated to achieve a higher additional yield.

Multi-Dimensionality Immunophenotyping Analyses of MAIT Cells Expressing Th1/Th17 Cytokines and Cytotoxic Markers in Latent Tuberculosis Diabetes Comorbidity.

Mucosal-associated invariant T (MAIT) cells are innate like, and play a major role in restricting disease caused by Mycobacterium tuberculosis (Mtb) disease before the activation of antigen-specific T cells. Additionally, the potential link and synergistic function between diabetes mellitus (DM) and tuberculosis (TB) has been recognized for a long time. However, the role of MAIT cells in latent TB (LTB) DM or pre-DM (PDM) and non-DM (NDM) comorbidities is not known. Hence, we examined the frequencies (represented as geometric means, GM) of unstimulated (UNS), mycobacterial (purified protein derivative (PPD) and whole-cell lysate (WCL)), and positive control (phorbol myristate acetate (P)/ionomycin (I)) antigen stimulated MAIT cells expressing Th1 (IFNγ, TNFα, and IL-2), Th17 (IL-17A, IL-17F, and IL-22), and cytotoxic (perforin (PFN), granzyme (GZE B), and granulysin (GNLSN)) markers in LTB comorbidities by uniform manifold approximation (UMAP) and flow cytometry. We also performed a correlation analysis of Th1/Th17 cytokines and cytotoxic markers with HbA1c, TST, and BMI, and diverse hematological and biochemical parameters. The UMAP analysis demonstrated that the percentage of MAIT cells was higher; T helper (Th)1 cytokine and cytotoxic (PFN) markers expressions were different in LTB-DM and PDM individuals in comparison to the LTB-NDM group on UMAP. Similarly, no significant difference was observed in the geometric means (GM) of MAIT cells expressing Th1, Th17, and cytotoxic markers between the study population under UNS conditions. In mycobacterial antigen stimulation, the GM of Th1 (IFNγ (PPD and WCL), TNFα (PPD and WCL), and IL-2 (PPD)), and Th17 (IL-17A, IL-17F, and IL-22 (PPD and/or WCL)) cytokines were significantly elevated and cytotoxic markers (PFN, GZE B, and GNLSN (PPD and WCL)) were significantly reduced in the LTB-DM and/or PDM group compared to the LTB-NDM group. Some of the Th1/Th17 cytokines and cytotoxic markers were significantly correlated with the parameters analyzed. Overall, we found that different Th1 cytokines and cytotoxic marker population clusters and increased Th1 and Th17 (IL-17A, IL-22) cytokines and diminished cytotoxic markers expressing MAIT cells are associated with LTB-PDM and DM comorbidities.

Intensive Case Finding of Tuberculosis and Diabetes Mellitus-Bidirectional Screening of Patients Attending a Tertiary Teaching Hospital in Rural Telangana, India

Introduction: Tuberculosis (TB) is a communicable disease of global public health threat. Poor and vulnerable populations are mainly affected with it. In association with Diabetes Mellitus (DM), TB may get worsen as increased relapse rates, delayed sputum culture conversion, increase in the case fatality rates etc. Conversely, TB may increase the incidence of DM, and worsen glycaemic control in diabetes patients. Aim: To study the effectiveness of bidirectional screening for TB and DM in rural hospital. Materials and Methods: A cross-sectional cohort study conducted at Medicine and Pulmonology department of MediCiti Institute of Medical Sciences (MIMS) for a period of nine months in June 2019-February 2020. All TB patients were screened for DM and vice versa. All TB patients were followed-up for treatment outcome of TB and all DM patients were followed-up for glycaemic control. Relative risk was calculated using incidence of outcome or control of disease in TB with DM patients to TB patients and DM with TB patients to DM patients. Results: Of 256 TB patients, 38 (14.8%) were TB with DM cases. All 256 patients were followed-up for TB treatment outcome, 100% TB patients without DM had recovery, whereas 97.3% TB patients with DM had recovery after two months of therapy. Relative risk of DM on TB outcome was 0.97. Of 256 DM patients screened, 9 (3.5%) had been newly diagnosed with TB. All 256 people were followed-up for impact on glycaemic control. Relative risk of TB on glycemic control was 1.87. Conclusion: Bidirectional screening would potentially improve care and prevention of TB and DM.

Pulmonary tuberculosis patients with diabetes mellitus have a more severe degree of chest X-ray compared to pulmonary tuberculosis patients without diabetes mellitus

Introduction: Pulmonary tuberculosis (TB) cases increase along with the increase in diabetes mellitus (DM) cases. The purpose of this study is to compare the description of Thorax X-ray severity between pulmonary TB patients without DM and pulmonary TB patients with DM.

Diabetes mellitus and HIV infection among active tuberculosis patients in Northwest Ethiopia: health facility-based cross-sectional study

BackgroundThe prevalence of diabetes mellitus (DM) is increasing globally and its comorbidity with tuberculosis (TB) is re-emerging, especially in low- and middle-income countries.ObjectiveThe main aim of this study is to determine the prevalence of DM and HIV infection and their associated risk factors among active tuberculosis patients in Northwest Ethiopia.MethodsThis hospital-based cross-sectional study was conducted between February 1st and June 30th, 2017 among active TB patients in two hospitals of Northwest Ethiopia. Two hundred and sixty-seven active TB cases aged 18 years or older were screened for diabetes using fasting blood glucose (FBG) test. Semi-structured questionnaires were used to collect demographic data, lifestyle habits and clinical data. Identification of pre-diabetes or diabetes in TB patients was achieved according to American Diabetes Association guidelines (2016).ResultsPrevalence of DM and TB comorbidity was 11.5% (95% confidence interval, CI 7.8–15.2) compared to 24.9% (95% CI 20.1–30.1) for pre-diabetes. Prevalence of HIV/TB co-infection was 21.9% (95% CI 16.7–26.8). Risk of DM was higher in TB patients from a rural location (adjusted odds ratio, aOR 3.13, 95% CI 1.02–9.62, p = 0.046). Similarly, DM was higher in TB patients who have a family history of DM (aOR 4.54, 95% CI 1.31–15.68, p = 0.017). Furthermore, HIV/TB co-infection was identified as a predictor of DM comorbidity in active TB patients (aOR 5.11, 95% CI 2.01–12.98, p = 0.001).ConclusionThe magnitude of DM and pre-diabetes in active TB patients in Northwest Ethiopia was high, warranting collaborative efforts to improve screening and adopt better clinical management strategies for DM–TB comorbid patients. Furthermore, being rural residents, family history of DM and HIV/TB co-infection were found to associate with DM among TB patients, highlighting the importance of the above-mentioned risk factors in the clinical management of this comorbidity.

Study of Latent Tuberculosis among Type 1 Diabetic Children in Zagazig University Pediatric Hospital

Background: In certain places, tuberculosis (TB) and diabetes mellitus (DM) are strongly linked as frequent comorbidities and might be termed epidemics combined. Objective: The present work aimed to detect relationship between type 1 DM (T1DM) and latent TB. Patients and Methods: This comparative cross-sectional study was conducted over the period from October 2019 to October 2020. It included 81 cases had type 1 DM and 81 healthy children as control group. This study was conducted at Zagazig University Pediatric Hospital. All patients were subjected to the following: Full history taking, full general examination, and investigation (Tuberculin test and chest X ray). Results: In the current study, 42% were male and (58%) were female. In the present work, there was no statistically significant difference between cases group and controls group regarding anthropometric measurements. This study showed that, the percentage of positive tuberculin test was higher among cases group than controls group (32.1%, 7.4%) p value< 0.001. OR estimate for DM on risk of TB was 5.9 (95% CI 2.27 to 15.33). Conclusion: There was no statistically significant difference between diabetic group and control group regarding sex, age, weight, and height. There was no statistically significant difference between diabetic and control group regarding contact with patient with TB and passive smoking. The percentage of positive tuberculin test was higher among diabetic group than control group.

Identification of Hub Genes Associated with Diabetes Mellitus and Tuberculosis Using Bioinformatic Analysis.

PurposeTo investigate the potential pathophysiological association between tuberculosis (TB) and diabetes mellitus (DM) using bioinformatic analyses.Patients and MethodsGene expression datasets for healthy controls (HCs), TB patients, DM patients, TB+DM patients (GSE114192), and metformin-treated cells (GSE102677) were obtained from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were identified from pairwise dataset comparisons TB vs HCs and DM vs HCs. DEGs were verified by comparing them to DEGs for TB+DM vs HCs. Enrichment analysis of DEGs common to all three dataset comparisons was conducted using DAVID. The protein–protein interaction (PPI) network was established via STRING and visualised in Cytoscape. Hub genes were identified using the Cytoscape plug-in cytoHubba and then were verified using reverse transcription-quantitative polymerase chain reaction (RT-qPCR) analysis. Targeted miRNA prediction analysis identified metformin treatment-induced gene expression changes in peripheral blood mononuclear cells.ResultsA total of 422 DEGs were common to all three dataset comparisons. Functional enrichment analysis revealed these DEGs were enriched for functional terms of type I interferon signaling pathway, innate immune response, inflammatory response, and infectious diseases. Ten hub genes identified using PPI network analysis were screened for interactions with metformin target gene INS using cytoHubba based on maximal clique centrality (MCC) score. Subsequently, five hub genes were predicted to functionally interact with INS, including STAT1, IFIT3, RSAD2, IFI44L, and XAF1, as verified by RT-qPCR. Meanwhile, seven miRNAs (miR-3680-3p, miR-3059-5p, miR-629-3p, miR-29b-2-5p, miR-514b-5p, miR-4755-5p, miR-4691-3p) were associated with regulation of hub genes. Notably, six hub genes (STAT1, IFIT3, RSAD2, ISG15, IFI44, IFI6) were down-regulated in cells exposed to both metformin and Mycobacterium tuberculosis antigens.ConclusionNetwork hub genes hold promise as disease status biomarkers and as metformin treatment targets for alleviating TB and DM. This study describes a strategy for exploring pathogenic mechanisms of diseases such as TB and DM.