Tuberculosis (TB) poses distinct public health challenges across different economic contexts. In countries with widespread TB, quick diagnosis and effective treatment are crucial for managing and preventing the disease. As TB becomes less common, more cases are likely to stem from the reactivation of latent TB infections (LTBI). In areas with moderate to low TB rates, the disease tends to cluster in specific high-risk groups. An adaptive strategy tailored to local epidemiological patterns is necessary, with growing attention on the social determinants and risk factors influencing TB.[1]
Diabetes mellitus (DM) significantly heightens the risk of active TB, leads to poorer treatment outcomes, and increases the chance of TB recurrence. Studies show that DM increases TB risk by about twice (RR of 2.03) in low- and moderate-incidence settings. In these countries, DM is more common among the elderly, paralleling the aging population trend. The demographic shift in TB is also towards the elderly, except among migrants. Those with DM, particularly in healthcare settings, are more exposed to TB. Generally, men have a higher proportion of TB linked to DM than women, except in Asian populations. DM impacts TB both by directly increasing individual risk and indirectly by enhancing transmission. Interestingly, obesity appears to reduce TB risk by about two-thirds compared to normal weight, even after accounting for DM and other factors.[1]A study was carried out from 2016 to 2019 in a large hospital in metro Atlanta, Georgia, looking at newly diagnosed, HIV-negative adults with type 2 diabetes (T2DM) who had never had tuberculosis (TB). The study compared cases (adults over 21 with T2DM diagnosed within three years) with controls (adults without T2DM). Most participants were African American, with 92.9% of cases and 79.4% of controls. Cases were older, averaging 54 years old compared to 51 for controls. Health-wise, fewer cases smoked daily (24.7% vs. 35.3% in controls), but cases had higher occurrences of high cholesterol, high blood pressure, and obesity.[2]
The study found that latent tuberculosis infection (LTBI) was less common in those with T2DM (9.2%) than in controls (14.7%). After considering age and gender, the likelihood of LTBI in cases was about half that in controls. When looking at blood sugar control, measured by HbA1c, there wasn't a big difference between those with or without LTBI in either group. However, higher HbA1c levels in people with LTBI were linked to higher QFT nil values, but not with other TB test results. This research sheds light on how T2DM might relate to LTBI among this specific group.[2]
References:
1. 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.
2. Salindri, A.D., Haw, J.S., Amere, G.A., Alese, J.T., Umpierrez, G.E. and Magee, M.J., 2021. Latent tuberculosis infection among patients with and without type-2 diabetes mellitus: results from a hospital case-control study in Atlanta. BMC Research Notes, 14(1), p.252.
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