Diabetes mellitus and tuberculosis

A systematic review of studies on diabetes mellitus (DM) and tuberculosis (TB) risk encompassed multiple WHO regions, including five in the Americas (Peru, USA, Canada, Brazil), six in Europe (Spain, Greenland/Denmark, UK), one in Africa (Ethiopia), one in the Eastern Mediterranean (Yemen), 25 in the Western Pacific (China, Singapore), and 11 in Southeast Asia (India, South Korea, Thailand). These studies primarily focused on adults, with nine also including children and adolescents. The diagnosis of DM was generally based on clinical records, fasting blood glucose levels, or glucose-lowering prescriptions, with limited differentiation between type 1 and type 2 diabetes.[1] See also: https://tbreadingnotes.blogspot.com/2024/07/feasibility-of-achieving-2025-who.html

The evidence from these studies suggests that DM may increase the risk of TB. Various metrics showed a heightened risk, with a hazard ratio (HR) of 1.90 (95% CI 1.51–2.40), an odds ratio (OR) of 1.61 (95% CI 1.27–2.04), and a relative risk (RR) of 1.60 (95% CI 1.42–1.80), though all findings had low to moderate certainty due to potential biases and inconsistencies. Furthermore, DM appears to elevate the risk of TB recurrence, with a hazard ratio of 1.35 (95% CI 0.76–2.42), although results varied significantly. The data suggests that the risk of TB may be particularly high within the first decade after DM diagnosis, and possibly extends beyond 10 years. Reducing the burden of diabetes could play a crucial role in TB elimination efforts, highlighting the need for integrated strategies to address both conditions.[1] See also: https://tbreadingnotes.blogspot.com/2024/07/cost-effectiveness-and-resource.html

The study of Type 2 Diabetes Mellitus (DM2) as a risk factor for Tuberculosis (TB) is complicated by the vast heterogeneity of populations worldwide. Factors such as age, access to medical care, the level of glucose control, the types and number of complications associated with DM2, and the availability of medications can all influence the outcomes of research in this area. This complexity is further compounded by regional differences in healthcare infrastructure and socioeconomic conditions, making it challenging to generalize findings across different populations. Despite these challenges, the study indicates that military personnel with DM2 experience a higher prevalence of recurrent TB compared to those without the condition, as well as a more rapid increase in cumulative risk for recurrent TB over time.[2] See also: https://tbreadingnotes.blogspot.com/2024/07/ambient-air-pollution-and-risk-of.html

In countries with limited to moderate healthcare resources, such as Peru, where both TB and DM2 are prevalent, military personnel with DM2 may be at heightened risk, particularly due to exposure in fieldwork conditions. However, despite these findings suggesting a possible link, the relationship between DM2 and recurrent TB in military personnel was not found to be statistically significant. This highlights the need for further research to better understand the role of contextual factors, such as resource availability and environmental exposure, in shaping the relationship between DM2 and TB. Understanding these nuances is crucial for developing targeted interventions, especially in resource-limited settings where both diseases are major public health concerns.[2] See also: https://tbreadingnotes.blogspot.com/2024/07/tuberculosis-in-healthcare-workers.html

References:

1. Franco, J.V., Bongaerts, B., Metzendorf, M.I., Risso, A., Guo, Y., Silva, L.P., Boeckmann, M., Schlesinger, S., Damen, J.A., Richter, B. and Baddeley, A., 2024. Diabetes as a risk factor for tuberculosis disease. The Cochrane database of systematic reviews, 8, p.CD016013. 

2. Alvarado-Valdivia, N.T., Flores, J.A., Inolopú, J.L. and Rosales-Rimache, J.A., 2024. Type 2 diabetes mellitus and recurrent Tuberculosis: A retrospective cohort in Peruvian military workers. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 35, p.100432.