Diabetes mellitus among adults with tuberculosis in the USA, 2010–2017

Abstract

<jats:sec><jats:title>Introduction</jats:title><jats:p>To describe diabetes trends among adults with incident tuberculosis (TB) disease and examine diabetes-associated TB characteristics and patient outcomes in the USA.</jats:p></jats:sec><jats:sec><jats:title>Research design and methods</jats:title><jats:p>We examined all 71 855 persons aged ≥20 years with incident TB disease reported to the National Tuberculosis Surveillance System during 2010–2017. We performed multivariable logistic regression, comparing characteristics and outcomes among patients with TB reported to have diabetes and those whose diabetes status was unknown.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>An overall 18% (n=13 281) of the 71 855 adults with incident TB disease were reported as also having diabetes; the annual proportion increased from 15% in 2010 to 22% in 2017. Among patients aged ≥45 years with both TB and diabetes, the adjusted OR for cavitary or sputum smear-positive TB was 1.7 and 1.5, respectively (95% CIs 1.5 to 1.8 and 1.4 to 1.6). Patients with TB and diabetes had 30% greater odds of dying and took longer to achieve negative <jats:italic>Mycobacterium tuberculosis</jats:italic> cultures and complete treatment.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>The prevalence of reported diabetes among adults with TB disease has increased. Having diabetes as a comorbidity negatively affects patient outcomes. In accordance with national recommendations, all patients aged ≥45 years and all younger patients who have risk factors for diabetes should be screened for diabetes at the start of TB treatment.</jats:p></jats:sec>

Trend and factors associated with Tuberculosis-Diabetes Mellitus comorbidity in a Northeastern Brazilian municipality

“…Corroborating such findings, studies conducted in the United States (37) and in Spain (38) have also shown an increase in comorbidity prevalence over time. Although the number of TB cases has been decreasing in countries like the United States, the prevalence of DM as comorbidity reported among adults with TB has steadily grown due to the high DM prevalence (37) .…”

“…Besides, alterations in lung function and mucociliary clearance in older adults, associated with the immunological vulnerability caused by DM, favor the development of TB (14) . DM and the physiological aging process synergistically reduce interferon-gamma levels, impairing cell-mediated immunity that contributes to the activation of long-standing latent TB (37) .…”

Tuberculous Lymphadenitis in Immunocompromised Patients: A Case Report

“…All patients aged ≥45 years old and all younger patients with risk factors for diabetes should be screened for diabetes at the beginning of TB treatment. 11 Diabetes may affect the natural history of TB in many ways, resulting in potentially increased risks of TB infection, clearly much higher chances of TB disease, and poorer TB treatment outcomes, especially mortality both during and after the end of treatment. 12 There are various challenges and substantial evidence with gaps regarding the management of TBLN with a pre-existing condition such as HIV or diabetes and the management of TBLN only.…”

Evaluation of the T-SPOT.TB test, oxidation-related factors, and antimicrobial peptide LL-37 in the diagnosis of pulmonary tuberculosis with type 2 diabetes

“…Inclusion criteria for the combined group were: (1) diagnosed with TB according to guidelines for the diagnosis and treatment of TB published by the Chinese Medical Association, 11 including pathological tissue biopsy and etiological examination; (2) diagnosed with type 2 diabetes according to guidelines for the prevention and treatment of type 2 diabetes in China; 12 (3) positive acid-fast staining of a sputum smear; (4)…”

“…3 Compared with patients with TB alone, patients with TB and diabetes have a worse prognosis and a higher mortality rate during anti-TB treatment. 4 Therefore, a reliable diagnostic method is of great clinical importance for defining the treatment plan and improving the survival rate of patients with TB.…”