Background: The increasing prevalence and convergence of type 2 diabetes mellitus (DM) and active tuberculosis (TB) comorbidity, especially in adults in the lower-and middle-income countries, demand new approaches to control the ‘syndemic’. Consequently, we set out to investigate the possibility of early detection of prediabetes mellitus and/or latent tuberculosis infection using novel method.Methods: This was a case-control study of 105 adults classified into 4 groups: Healthy Community Controls (HCC, n=30); Prediabetes mellitus (PDM, n=25); Latent Tuberculosis Infection (LTBI, n=23); Individuals with Prediabetes mellitus+Latent Tuberculosis Infection (PDM+LTBI, n=27). Sera collected were assayed for high-sensitivity C-reactive protein (hs-CRP) using the ultra-sensitive Human high sensitivity C-reactive protein ELISA Kit (Melsin Medical Co., Ltd, China). Other ancillary tests and measurements done include Erythrocyte Sedimentation Rate, serum Glycated-hemoglobin (HbA1c), Interferon-gamma (INF-ϒ) and Waist circumference.Results: A total of 88 (83.8%) of the enrolled participants had full complement of results and were included in the analysis of four study groups: HCC (n=25), PDM (n=21), LTBI (n=19) and PDM+ LTBI (n=23). With respect to the serum biomarkers, isolated PDM and LTBI cases recorded significantly higher HbA1c (%) and INF-ϒ positivity respectively. Predictors of PDM+LTBI show statistically significant higher tertile (T3), representing elevated hs-CRP levels, (OR=6.50, 95% CI=4.83-22.39, p=0.0037).Conclusions: This study revealed that persons harboring the two associated asymptomatic conditions, PDM + LTBI have higher inflammatory state detectable by assaying the biomarker, hs-CRP, which could be used for ‘one-time bi-directional targeted screening’ for PDM in LTBI and vice versa.
Type 2 diabetes mellitus (DM) is commonly associated with pulmonary tuberculosis (TB) and vice versa. Although most individuals with DM and TB pass through intermediate state of pre-diabetes mellitus (PDM) and latent tuberculosis infection (LTBI) respectively, however, data is scant on PDM and LTBI in co-endemic populations to inform recommendations on intervention in those settings. This study aimed to assess the prevalence of PDM and LTBI and determine the susceptibility factors among presumably low-risk adults in a high DM-and TB setting. A cross-sectional study of 352 ablebodied adults was conducted in three communities representative of the southern Nigeria population. Socio-demographic and anthropometric data of the participants were collected using a modified WHO STEPS Wise instrument. A single random blood sample was used to measure glycated hemoglobin (HbA 1c) using Cobas c111 Auto-analyzer and interferon-gamma (INF-γ) production with the aid of Quantiferon TB-Gold-In Tube (QFT-GIT) kit. Pre-diabetes was defined as HbA 1c between 5.7-6.4% and LTBI as INF-γ positivity (≥0.35 IU/ml). Overall, the prevalence of PDM was 29 (8.2%) (95% CI: 6.4-9.4%) and LTBI 83 (23.6%) (95% CI: 21.6-27.3%), while 9 (2.6%) had dual PDM-LTBI. The urbanites recorded higher PDM 15 (12.8%) (X 2 =6.340, p=0.022) whereas LTBI was higher among villagers 48 (43.6%) (X 2 =36.503, p=0.0001). Risk factors associated with PDM and LTBI were: residence status, aging, smoking, familial DM and non-BCG vaccination. Aging was the single most important predictor of PDM (X 2 =8.469, p=0.007), LTBI (X 2 =59.541, p=0.001); with aged 50-59 years having four-fold higher risk of PDM-LTBI (OR=4.72, 95% CI=3.25; p=0.0001). These findings indicate that one in twelve and one in four presumably healthy persons screened were found to harbor PDM and LTBI respectively. There is a twin epidemic of PDM and LTBI among southern Nigeria adults. Susceptibility pattern suggests environmental, familial and cumulative lifetime risks. 'Syndemic' DM and TB in the area is imminent in the absence of timeous intervention.
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