Purpose To estimate the association between diabetes mellitus (DM) and all-cause mortality during tuberculosis (TB) treatment. Methods From 2009 to 2012 a retrospective cohort study among reported TB cases in Georgia was conducted. Patients aged ≥16 years were classified by DM and HIV status at time of TB diagnosis and followed during TB treatment to assess mortality. Hazard ratios (HR) were used to estimate the association between DM and death. Results Among 1,325 patients with TB disease, 151 (11.4%) had DM, 147 (11.1%) were HIV-infected, and 7 (0.5%) had both DM and HIV. Patients with TB-DM were more likely to have cavitary lung disease compared to those with TB alone (51.0% vs. 34.7%) and those with TB-HIV were more likely to have military/disseminated disease (12.9% vs. 3.4%) and resistance to rifampin or isoniazid (21.8% vs. 9.0%) compared with those without HIV infection (p<0.05). In multivariable analysis, DM was not associated with death during TB treatment (HR 1.22, 95% CI 0.70–2.12) or any death (aOR 1.05, 95% CI 0.60–1.84). Conclusions Among TB patients in Georgia, the prevalence of co-morbid DM and co-infection with HIV was nearly identical. In adjusted models, TB patients with DM did not have increased risk of all-cause mortality.

Summary Scarce data exist on the relationship between diabetes and extrapulmonary tuberculosis (EPTB). We evaluated whether diabetes impacts site of TB and risk of death in patients with EPTB. We evaluated a cohort of TB cases from the state of Georgia between 2009 and 2012. Patients aged ≥16 years were classified by diabetes status according to medical records. Site of EPTB was determined by culture and/or state TB classification. Death was defined by all-cause mortality. Of 1325 eligible reported TB cases, 369 (27.8%) had any EPTB including 258 (19.5%) with only EPTB and 111 (8.4%) with pulmonary TB and EPTB. Of all TB cases, 158 had diabetes (11.9%). In multivariable analysis, the odds of any EPTB was similar in patients with and without diabetes [adjusted odds ratio 1.04, 95% confidence interval (CI) 0.70–1.56]. The risk of death was 23.8% in patients with EPTB and diabetes vs. 9.8% in those with no diabetes (P < 0.01); after adjusting for covariates the difference was not significant (aRR 1.19, 95% CI 0.54–2.63). Diabetes was common in patients with EPTB and risk of death was high. Improved understanding of the relationship between diabetes and EPTB is critical to determine the extent that diabetes affects TB diagnosis and clinical management.

Standard tuberculosis case reporting captures incarceration at diagnosis only. This retrospective analysis of 106 US-born adults with prevalent tuberculosis in 2011 found that 46.2% had documented histories of being in jail or prison, including 16.0% during the year before diagnosis.