Tuberculosis and Diabetes in Southern Mexico

Abstract

OBJECTIVE—To determine the impact of diabetes on the rates of tuberculosis in a region where both diseases are prevalent. RESEARCH DESIGN AND METHODS—Data from a population-based cohort of patients with pulmonary tuberculosis undergoing clinical and mycobacteriologic evaluation (isolation, identification, drug-susceptibility testing, and IS6110-based genotyping and spoligotyping) were linked to the 2000 National Health Survey (ENSA2000), a national probabilistic, polystage, stratified, cluster household survey of the civilian, noninstitutionalized population of Mexico. RESULTS—From March 1995 to March 2003, 581 patients with Mycobacterium tuberculosis culture and fingerprint were diagnosed, 29.6% of whom had been diagnosed previously with diabetes by a physician. According to the ENSA2000, the estimated prevalence of diabetes in the study area was 5.3% (95% CI 4.1–6.5). The estimated rates of tuberculosis for the study area were greater for patients with diabetes than for nondiabetic individuals (209.5 vs. 30.7 per 100,000 person-years, P < 0.0001). CONCLUSIONS—In this setting, the rate of tuberculosis was increased 6.8-fold (95% CI 5.7–8.2, P < 0.0001) in patients with diabetes due to increases in both reactivated and recently transmitted infection. Comorbidity with diabetes may increase tuberculosis rates as much as coinfection with human immunodeficiency virus (HIV), with important implications for the allocation of health care resources.

Type 2 Diabetes Mellitus Coincident with Pulmonary Tuberculosis Is Associated with Heightened Systemic Type 1, Type 17, and Other Proinflammatory Cytokines

“…The immunological basis for susceptibility to tuberculosis among those with diabetes mellitus is not well understood. One possible mechanism is that an impaired immune response in diabetic patients facilitates either primary infection with tuberculosis or reactivation of latent tuberculosis (11). Studies examining the innate and adaptive immune response to microbial antigens in diabetic patients suggest that these responses are compromised, particularly in patients with chronic hyperglycemia (12)(13)(14).…”

Cross-sectional assessment reveals high diabetes prevalence among newly-diagnosed tuberculosis cases

“…[6][7][8][9][10][11][12][13][14][15][16][17] One quarter of the cases of TB in these medically-underserved communities along the Texas-Mexico border were attributable to diabetes. With diabetes on the rise in TB-endemic areas, our findings highlight the re-emerging impact of diabetes, now type 2, on TB control in regions of the world where both diseases are prevalent.…”

“…4,5 This association (now with type 2 diabetes) was recognized again in the 1990s [6][7][8][9] and is currently supported by a growing body of literature. [6][7][8][9][10][11][12][13][14][15][16][17] According to a recent meta-analysis, diabetes patients have three times the risk of contracting TB as non-diabetics (95% confidence interval, CI: 2.3-4.3) 18 and studies report the fraction of TB cases attributable to diabetes to be between 15% and 25%. 9,13,16 The biological basis for the association between both diseases is not fully understood but studies suggest that diabetes depresses the immune response, which in turn facilitates infection with Mycobacterium tuberculosis and/or progression to symptomatic disease.…”

“…4,[19][20][21][22] Despite the suggested importance of diabetes as a risk factor for TB, most contemporary studies are based on secondary data or self-reported diabetes status. [6][7][8][9][10][11][12][13][14][15][16][17] The contribution of diabetes to the burden of TB may be more conspicuous in countries where both diseases are highly prevalent: Bangladesh, Brazil, China, India, Indonesia, Pakistan, and the Russian Federation are high-burden countries and rank among the 10 countries with the highest numbers of diabetes patients 2, 23 and also classified as high-burden for TB. However, the risk of TB attributable to diabetes has only been reported for India and it was estimated from secondary data.…”

Tuberculosis in the Elderly

“…Örneğin TB reaktivasyonunu kolaylaştıran sigara içiminin önlenmesi ve şeker regülasyonunun sağlanması, TB hastalığının ortaya çık-masını azaltacaktır. 33,34 Yetersiz beslenme de TB gelişimini kolaylaştıran ve hastalığı ağırlaştıran bir faktördür. 35 Yeterli ölçüde protein, kalori ve vitamin içeren dengeli bir diyet uygulanması, hem genel sağlık anlamında hem de TB gelişimini önlemede önemlidir.…”