Prevalence and Determinants of Pre-diabetes and Latent Tuberculosis Infection Among Apparently Healthy Adults in Three Communities in Southern Nigeria

Abstract

Type 2 diabetes mellitus (DM) is commonly associated with pulmonary tuberculosis (TB) and vice versa. Although most individuals with DM and TB pass through intermediate state of pre-diabetes mellitus (PDM) and latent tuberculosis infection (LTBI) respectively, however, data is scant on PDM and LTBI in co-endemic populations to inform recommendations on intervention in those settings. This study aimed to assess the prevalence of PDM and LTBI and determine the susceptibility factors among presumably low-risk adults in a high DM-and TB setting. A cross-sectional study of 352 ablebodied adults was conducted in three communities representative of the southern Nigeria population. Socio-demographic and anthropometric data of the participants were collected using a modified WHO STEPS Wise instrument. A single random blood sample was used to measure glycated hemoglobin (HbA 1c) using Cobas c111 Auto-analyzer and interferon-gamma (INF-γ) production with the aid of Quantiferon TB-Gold-In Tube (QFT-GIT) kit. Pre-diabetes was defined as HbA 1c between 5.7-6.4% and LTBI as INF-γ positivity (≥0.35 IU/ml). Overall, the prevalence of PDM was 29 (8.2%) (95% CI: 6.4-9.4%) and LTBI 83 (23.6%) (95% CI: 21.6-27.3%), while 9 (2.6%) had dual PDM-LTBI. The urbanites recorded higher PDM 15 (12.8%) (X 2 =6.340, p=0.022) whereas LTBI was higher among villagers 48 (43.6%) (X 2 =36.503, p=0.0001). Risk factors associated with PDM and LTBI were: residence status, aging, smoking, familial DM and non-BCG vaccination. Aging was the single most important predictor of PDM (X 2 =8.469, p=0.007), LTBI (X 2 =59.541, p=0.001); with aged 50-59 years having four-fold higher risk of PDM-LTBI (OR=4.72, 95% CI=3.25; p=0.0001). These findings indicate that one in twelve and one in four presumably healthy persons screened were found to harbor PDM and LTBI respectively. There is a twin epidemic of PDM and LTBI among southern Nigeria adults. Susceptibility pattern suggests environmental, familial and cumulative lifetime risks. 'Syndemic' DM and TB in the area is imminent in the absence of timeous intervention.

Elevated high-sensitivity C-reactive protein among apparently healthy adults with concomitant prediabetes and latent tuberculosis infection in Nigeria

“…Details of the study design and recruitment process have been published elsewhere. 20,21 Initially, the study population consisted of 105 adults classified into four groups: 1) Clinically Healthy Community Controls (HCC, n=30); 2) Prediabetes Mellitus (PDM, n=25); 3) Latent Tuberculosis Infection (LTBI, n=23) and 4) Those with concomitant Prediabetes Mellitus and Latent Tuberculosis Infection (PDM+LTBI, n=27).…”

“…Total Cholesterol (TC), Low Density Lipoprotein (LDL-C3) and High Density Lipoprotein (HDL-C4) and glycated hemoglobin A1c (HbA1c) using the Cobas CIII system Auto-analyzer (Roche/Hitachi Diagnostic) as previously described. 21,24…”