Tuberculosis and diabetes: bidirectional association in a UK primary care data set

Abstract

BackgroundMany studies have found an increased risk of pulmonary tuberculosis (PTB) among those with diabetes mellitus (DM). However, evidence on whether the association is bidirectional remains sparse. This study investigates DM rates among those with and without prior tuberculosis (TB) disease as well as the reverse.MethodsData on a UK general practice population, between 2003 and 2009, were obtained from The Health Improvement Network database. A series of retrospective cohort studies were completed. Individuals were successively classified as ‘exposed’ or ‘unexposed’ to TB, PTB, extrapulmonary TB (EPTB) or DM. Multivariate negative binomial regression was used to calculate incidence rate ratios (IRR) among each exposure group for outcomes of interest (TB, PTB, EPTB or DM in turn) adjusting for plausible confounding variables (age, sex, region, Townsend quintile and smoking status). Potential confounding due to ethnicity was adjusted for using McNamee’s external method.ResultsDM risk was substantially raised among individuals with a history of TB disease (IRR 5.65 (95% CI 5.19 to 6.16)), PTB (IRR 5.74 (95% CI 5.08 to 6.50)) and EPTB (IRR 4.66 (95% CI 3.94 to 5.51)) compared with those without; results were attenuated after external adjustment for ethnicity (IRR 2.33 (95% CI 2.14 to 2.53)). TB risk was raised modestly among individuals with DM (IRR 1.50 (95% CI 1.27 to 1.76)) and was attenuated slightly after adjustment for ethnicity (IRR 1.26 (95% CI 1.07 to 1.48)).ConclusionDM risk was raised among those with previous TB disease; this finding has implications for follow-up and screening of patients with TB, who may be at high risk of developing DM or related complications.

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“…This finding was consistent with a study conducted in United Kingdom. 39 However, the present study was inconsistent with study conducted in Bhopal in India and in South East of Amhara Region. 33,40 The possible reason for this might be due extra tuberculosis can affect pancreas and this can result in developing diabetes mellitus.…”

“…This finding was in line with study conducted in Pondicherry in India and in Nepal. 37,39 On the other hand, being female was also significantly associated with diabetes mellitus and tuberculosis comorbidity.…”

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“…La comorbilidad con DM también se asoció a una mayor PEES, pero no se obtuvo una significancia estadística, que puede deberse al tamaño de la población evaluada. Algunos estudios demuestran que la DM tiene relación con la presencia de mayor número de RAM a los fármacos de segunda línea (23) y afecta el resultado del tratamiento de TB, con incremento de la mortalidad (24). La DM implica mayor morbilidad, necesidad de mayor número de medicamentos y cuidados por especialistas.…”

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“…Some articles mention that TB itself could be a factor that could identify patients who would be more propense to future metabolic alterations 38 . Additionally, TB itself can cause tuberculous pancreatitis with the pancreatic endocrine hypofunction causing hyperglycemia 27 .…”