Associations between type 1 DM and pulmonary TB [TB0087]

  • Observational studies on diabetes and PTB (pulmonary tuberculosis) are impacted by reverse causality, confounding factors, and lack of specification regarding diabetes phenotypes, particularly between T1DM and T2DM.
  • T1DM is associated with metabolic disorders, such as disturbed glucose and lipid metabolism, obesity, and a higher susceptibility to PTB infections. An estimated 7.5% of TB cases are linked to poor glycemic control.
  • PTB patients often exhibit lower HDL-C, LDL-C, and total cholesterol levels. There is a log-linear relationship between BMI and TB incidence, with TB incidence decreasing by about 14% per unit increase in BMI.
  • Mendelian Randomization (MR) uses genetic variants as instrumental variables to clarify causal relationships, reducing biases from confounders and reverse causality.
  • MR analysis revealed:
    • A positive genetic association between T1DM and PTB.
    • HDL-C genetic predisposition correlates with increased PTB risk.
    • No causal links between PTB and other T1DM-related traits like FBG, HbA1c, FI, metabolic factors, or obesity.
  • Core assumptions of MR:
    1. Genetic variants must correlate strongly with the exposure (e.g., T1DM).
    2. Variants should be independent of confounders.
    3. Variants should influence the outcome (e.g., PTB) only via the exposure.
  • Limitations:
    • Lack of stratification by gender, age, and other demographic factors.
    • Most data were from European ancestry, raising concerns about generalizability.
  • Clinical recommendations:
    • PTB prevention should involve T1DM management and HDL-C control for better comanagement of T1DM and PTB in clinical settings.
    Source: Jiang, Y., Zhang, W., Wei, M., Yin, D., Tang, Y., Jia, W., Wang, C., Guo, J., Li, A. and Gong, Y., 2024. Associations between type 1 diabetes and pulmonary tuberculosis: a bidirectional mendelian randomization study. Diabetology & Metabolic Syndrome, 16(1), pp.1-9.


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