Association between diabetes mellitus and active tuberculosis: A systematic review and meta-analysis

Abstract

The burgeoning epidemic of diabetes mellitus (DM) is one of the major global health challenges. We systematically reviewed the published literature to provide a summary estimate of the association between DM and active tuberculosis (TB). We searched Medline and EMBASE databases for studies reporting adjusted estimates on the TB–DM association published before December 22, 2015, with no restrictions on region and language. In the meta-analysis, adjusted estimates were pooled using a DerSimonian-Laird random-effects model, according to study design. Risk of bias assessment and sensitivity analyses were conducted. 44 eligible studies were included, which consisted of 58,468,404 subjects from 16 countries. Compared with non-DM patients, DM patients had 3.59–fold (95% confidence interval (CI) 2.25–5.73), 1.55–fold (95% CI 1.39–1.72), and 2.09–fold (95% CI 1.71–2.55) increased risk of active TB in four prospective, 16 retrospective, and 17 case-control studies, respectively. Country income level (3.16–fold in low/middle–vs. 1.73–fold in high–income countries), background TB incidence (2.05–fold in countries with >50 vs. 1.89–fold in countries with ≤50 TB cases per 100,000 person-year), and geographical region (2.44–fold in Asia vs. 1.71–fold in Europe and 1.73–fold in USA/Canada) affected appreciably the estimated association, but potential risk of bias, type of population (general versus clinical), and potential for duplicate data, did not. Microbiological ascertainment for TB (3.03–fold) and/or blood testing for DM (3.10–fold), as well as uncontrolled DM (3.30–fold), resulted in stronger estimated association. DM is associated with a two- to four-fold increased risk of active TB. The association was stronger when ascertainment was based on biological testing rather than medical records or self-report. The burgeoning DM epidemic could impact upon the achievements of the WHO “End TB Strategy” for reducing TB incidence.

Miliary tuberculosis and herpes pharyngitis after a trip to a developing country: dangers of biologics

“…This is further exacerbated by the burgeoning DM epidemic which is a re-emerging global risk factor for TB, especially in developing countries 6. Risk of active TB is about twofold to fourfold higher in patients with type 1 or type 2 DM which also impacts WHO’s ‘End TB Strategy’ for reducing TB incidence 7. A more frequent rescreening strategy may offer a preventative solution to lower the TB burden in these rising immunocompromised hosts.…”

Coprevalence of type 2 diabetes mellitus and tuberculosis in low‐income and middle‐income countries: A systematic review

“…List of Abbreviations: AIDS, acquired immune deficiency syndrome; DM, diabetes mellitus; FPG, fasting plasma glucose; HIV, human immunodeficiency virus; LMIC, low-income and middle-income countries; OGTT, oral glucose tolerance test; RPG, random plasma glucose; TB, tuberculosis; EPTB, extrapulmonary tuberculosis; GNIPC, gross national income per capita; HbA1c, glycated haemoglobin; PTB, pulmonary tuberculosis; MDR-TB, multidrug resistant tuberculosis; PPD, purified protein derivative systematic review published in 2017 found that DM doubles lifetime TB risk (RR = 2.0), 15 while another systematic review and meta analysis published in 2017 found a greater than 3-fold increase in TB risk (RR = 3.59). 1 Additionally, T2DM has been shown to be a risk factor for falling into poverty, which is another important risk factor for TB. 16 Regardless of the true degree of relative risk, DM is a known risk factor for TB and 15% of the global TB burden is now attributable to DM.…”

“…Therefore, possible quality scores ranged from 0 to 7. The studies were classified into 3 groups: high quality (6-7) medium quality (3)(4)(5), and low quality (1)(2). Due to the diversity of study populations, study methods, nonreporting of standard errors, and wide heterogeneity of results, we did not metaanalyse the data and instead present the results in a narrative form.…”

“…A seminal systematic review published in 2008 by Jeon and Murray found that DM causes a 3‐fold lifetime increase in TB risk (relative risk = 3.11) . A more recent systematic review published in 2017 found that DM doubles lifetime TB risk (RR = 2.0), while another systematic review and meta analysis published in 2017 found a greater than 3‐fold increase in TB risk (RR = 3.59) . Additionally, T2DM has been shown to be a risk factor for falling into poverty, which is another important risk factor for TB .…”

“…Diabetes mellitus (DM) is an established risk factor for active tuberculosis (TB). 1 As globalization fuels rapid lifestyle changes throughout low-income and middle-income countries (LMIC), DM and TB are cooccurring in the same populations and in the same individuals. [2][3][4][5] Globally, DM prevalence is increasing rapidly.…”