Tuberculosis and diabetes in low and moderate tuberculosis incidence countries

Lee, P.H., Fu, H., Lee, M.R., Magee, M. and Lin, H.H., 2018. Tuberculosis and diabetes in low and moderate tuberculosis incidence countries. The International Journal of Tuberculosis and Lung Disease, 22(1), pp.7-16.

  • TB presents a public health challenge in both low- and middle-income countries and high-income countries, but in different ways.
  • In countries with a generalized TB epidemic, prompt diagnosis and effective treatment of active TB are essential for control and prevention.
  • As TB prevalence and incidence decline, a higher proportion of TB cases are expected to come from remote latent tuberculous infection (LTBI). In moderate-to-low burden settings, the TB epidemic is concentrated in specific high-risk and vulnerable populations.
  • There is a need for an adaptive approach at the country level based on local epidemiology. There is increasing interest in the role of social determinants and risk factors of TB.
  • Diabetes mellitus (DM) increases the risk of active TB, is associated with poor TB treatment outcomes, and leads to subsequent recurrence after anti-tuberculosis treatment. A pooled relative risk (RR) of 2.03 was found from 14 cohort studies, mostly conducted in low- and moderate-incidence settings.
  • Most DM patients in low and moderate TB incidence countries are elderly, and many of these countries are facing rapid population ageing.
  • The TB burden in low- and moderate-incidence countries is shifting towards the elderly, except in the migrant population.
  • Patients with DM may be more likely to be exposed to TB, especially in healthcare settings.
  • Males had a larger proportion of TB cases attributable to DM than females in most ethnic groups, except the Asian population.
  • DM has a significant impact on TB incidence in both high and low/moderate TB incidence countries.
  • DM affects TB epidemiology by increasing the risk of active TB at the individual level (direct effect) and by contributing to the transmission of TB to others (transmission effect).
  • Obese individuals had a nearly two-thirds reduction in TB risk compared to people with normal weight, after adjusting for DM and other confounding factors. 

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