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

Abstract

Increasing coprevalence of diabetes mellitus (DM) and tuberculosis (TB) in low-income and middle-income countries (LMICs) indicates a rising threat to the decades of progress made against TB and requires global attention. This systematic review provides a summary of type 2 diabetes and tuberculosis coprevalence in various LMICs. We searched PubMed, Ovid Medline, Embase, and PsychINFO databases for studies that provided estimates of TB-DM coprevalence in LMICs published between 1990 and 2016. Studies that were non-English and exclusively conducted in multidrug resistant-tuberculosis or type 1 diabetes and inpatient settings were excluded. We reviewed 84 studies from 31 countries. There were huge diversity of study designs and diagnostic methods used to estimate coprevalence, and this precluded pooling of the results. Most studies (n = 78) were from small, localized settings. The DM prevalence among TB patients in various LMICs varied from 1.8% to 45%, with the majority (n = 44) between 10% and 30%. The TB prevalence among people with DM ranged from 0.1% to 6.0% with most studies (n = 9) reporting prevalences less than 2%. Coprevalence of TB-DM was higher than general population prevalence of either diseases in these countries. This study underscores the need for intervention and more focused research on TB DM bidirectional screening programs in low-income and middle-income countries as well as integrated chronic disease management.

Diabetes in developing countries

“…The concept of a syndemic refers to synergistic (often not directly associated with the index disease) health problems that affect the health of a population in the context of persistent social and economic inequalities . Both HIV and tuberculosis are common in some African, South Asian, and South American countries, and can contribute to insulin resistance and diabetes . Conversely, the presence of diabetes increases the risk of tuberculosis .…”

Diabetes and tuberculosis: A closer and closer relationship

“…The correlation between diabetes and increased risk for TB infection is well known. 2 As a matter of fact, the same group had previously observed that the incidence of TB infection occurred most frequently within the first year from DM diagnosis. 3 On the contrary, Lee et al had shown that the prevalence of diabetes was higher in patients with pulmonary tuberculosis compared to the general population.…”

Infections and diabetes: Risks and mitigation with reference to India

“… The greater risk of contracting TB in diabetes, as well as reactivation of latent TB, is postulated to be due to a combination of susceptibility to infection with oxidative stress and increased tissue inflammation [ 8 ]. A recent systematic review on the co-prevalence of TB and diabetes in low and middle-income countries found that diabetes was found in 1.8–45% of individuals diagnosed with TB, and that 0.1–6% of individuals with diabetes had TB [ 9 ]. TB in diabetes has certain peculiar characteristics that make diagnosis and management difficult (see Box 1 ) [ 10 ].…”