The Association Between Diabetes Mellitus and the Risk of Latent Tuberculosis Infection: A Systematic Review and Meta-Analysis

Abstract

BackgroundThe estimated global latent tuberculosis infection (LTBI) burden indicates a large reservoir of population at risk of developing active tuberculosis (TB). Previous studies suggested diabetes mellitus (DM) might associate with LTBI, though still controversial. We aimed to systematically assess the association between DM and LTBI.MethodsWe searched PubMed, Embase, Cochrane Library and Web of Science. Observational studies reporting the number of LTBI and non-LTBI individuals with and without DM were included. Random-effects or fixed-effects models were used to estimate the pooled effect by risk ratios (RRs) and odds ratios (ORs) and its 95% confidence interval (CI), using the original number of participants involved.Results20 studies involving 4,055,082 participants were included. The pooled effect showed a significant association between DM and LTBI (for cohort studies, RR = 1.62, 95% CI: 1.02–2.56; for cross-sectional studies, OR = 1.55, 95% CI: 1.30–1.84). The pooled OR was high in studies with healthcare workers (5.27, 95% CI: 1.52–8.20), refugees (2.88, 95% CI: 1.93–4.29), sample size of 1,000–5,000 (1.99, 95% CI: 1.49–2.66), and male participants accounted for less than 40% (2.28, 95% CI: 1.28–4.06). Prediabetes also associated with LTBI (OR = 1.36, 95% CI: 1.01–1.84).ConclusionThe risk of LTBI was found to be a 60% increase in DM patients, compared with non-DM patients. LTBI screening among DM patients could be of vital importance. More studies are needed to explore appropriate strategies for targeted LTBI screening among DM patients.

The association between diabetes status and latent-TB IGRA levels from a cross-sectional study in eastern China

“…Diabetes was associated with an increased prevalence of LTBI in prior studies ( Barron et al., 2018 ). A previous systematic review and meta-analysis showed that diabetes was associated with a small increased risk of LTBI ( Lee et al., 2017 ), but a recent meta-analysis showed that the risk of LTBI was found to be a 60% increased risk in persons with diabetes and a 36% increased risk in prediabetes when compared with normoglycemia people ( Liu et al., 2022 ). In addition, there were studies indicating the increased risk of incident diabetes among individuals with LTBI ( Magee et al., 2022 ), demonstrating that the LTBI population was a vulnerable group of people who were susceptible to diabetes.…”

Immunologic, metabolic and genetic impact of diabetes on tuberculosis susceptibility

“…A large cross-sectional study of the US national data also reported that T2DM significantly increases LTBI risk (adjusted odds ratio: 1.90, 95% confidence interval: 1.15–3.14) ( 37 ). Correspondingly, a systematic review involving 20 studies also reported a significant LTBI risk by T2DM (for cohort studies, relative risk: 1.62, 95% confidence interval: 1.02–2.56; for cross-sectional studies, odds ratio: 1.55, 95% confidence interval: 1.30–1.84) ( 38 ). The association between T2DM and ATB has been well established ( 41 ), with T2DM increasing the risk for ATB development by greater than 3-fold ( 42 ).…”

“…2 Epidemiological effects of T2DM on TB 2.1 T2DM increases the risk of LTBI and ATB T2DM has been reported as a primary Mtb infection risk factor (37,38). Patients with T2DM (43.4%) and pre-diabetes (39.1%) had significantly more LTBI than those without T2DM (25.9%), with a strong association between T2DM and LTBI (adjusted odds ratio: 2.3, 95% confidence interval: 1.2-4.5) (39).…”

Impact of diabetes mellitus on immunity to latent tuberculosis infection

“…In a meta-analysis published in 2017, DM was associated with a small but significant risk for LTBI ( 9 ). Another more recent meta-analysis concluded that DM increased the risk for LTBI by 60% ( 18 ). Finally, more recent comprehensive longitudinal data indicate that LTBI is associated with increased diabetes incidence (hazard ratio of 1.4) in US Veterans ( 19 ).…”