Prevalence and associated factors of tuberculosis and diabetes mellitus comorbidity: A systematic review

Abstract

IntroductionThe dual burden of tuberculosis (TB) and diabetes mellitus (DM) has become a major global public health concern. There is mounting evidence from different countries on the burden of TB and DM comorbidity. The objective of this systematic review was to summarize the existing evidence on prevalence and associated/risk factors of TBDM comorbidity at global and regional levels.MethodsOvid Medline, Embase, Global health, Cochrane library, Web of science and Scopus Elsevier databases were searched to identify eligible articles for the systematic review. Data were extracted using standardized excel form and pilot tested. Median with interquartile range (IQR) was used to estimate prevalence of TBDM comorbidity. Associated/risk factors that were identified from individual studies were thematically analyzed and described.ResultsThe prevalence of DM among TB patients ranged from 1.9% to 45%. The overall median global prevalence was 16% (IQR 9.0%-25.3%) Similarly, the prevalence of TB among DM patients ranged from 0.38% to 14% and the overall median global prevalence was 4.1% (IQR 1.8%-6.2%). The highest prevalence of DM among TB patients is observed in the studied countries of Asia, North America and Oceania. On the contrary, the prevalence of TB among DM patients is low globally, but relatively higher in the studied countries of Asia and the African continents. Sex, older age, urban residence, tobacco smoking, sedentary lifestyle, poor glycemic control, having family history of DM and TB illness were among the variables identified as associated/risk factors for TBDM comorbidity.ConclusionThis systematic review revealed that there is a high burden of DM among TB patients at global level. On the contrary, the global prevalence of TB among DM patients is low. Assessing the magnitude and risk/associated factors of TBDM comorbidity at country/local level is crucial before making decisions to undertake TBDM integrated services.

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

“…Although the focus of our review was different from that of Workneh et al, and despite a significant variation in the included studies, our report produced strikingly similar regional coprevalences, each lending credence to the other . Due to differences in search strategy and inclusion criteria, this article includes 38 studies that are not included in Workneh et al's review.…”

“…Although the focus of our review was different from that of Workneh et al, and despite a significant variation in the included studies, our report produced strikingly similar regional coprevalences, each lending credence to the other. 20 This review also demonstrated that many TB-DM studies in LMICs take place in urban, tertiary care centres. As such, many low-income populations in these countries, such as rural dwellers and those who do not receive care in large referral settings, were largely absent from this analysis, which reflects the fact that most global DM research includes only higher-income urban populations.…”

“…This review systematically evaluates the current literature to provide a clear picture of the status of TB‐DM co‐prevalence in LMICs. One systematic review by Workneh et al published in 2017 provides a summary of global diabetes‐TB coprevalence. Workneh et al analysed the factors associated with TB‐DM comorbidity and mortality globally without specifically focusing on LMIC countries where the burden of TB and DM are highest.…”

Tuberculosis and Diabetes Mellitus- Not a Sweet Association!

“…[8,9] Workneh MH et al systemic review shows an overall global median DM prevalence of 16% (IQR 9.0 -25.3%). [10] Proportion of DM among Patients with different Bacillary Load This study shows proportion of DM was higher among patients with high bacillary load. Matthew J Magee et al shows that patients with TB and DM were more likely to have a higher AFB smear grade (aOR 2.37, 95% CI 1.14 -4.94).…”

Pulmonary Tuberculosis Screening in Patients with Diabetes Mellitus

“…The risk factors for DM-TB comorbidity are represented by male gender, old age, marital status, smoker status, alcohol consumption, physical inactivity, urban environment, crowded areas, insanitary conditions, low educational level and reduced economic status [6][7][8][9][10][11]. Patients with DM and TB have a family history of TB, family history of DM, higher body mass index and decreased glycemic control [6,7]. Also, they are predisposed to pulmonary cavities, hemoptysis and sputum positive at diagnosis, which persist positive after one or two months of treatment [5].…”