Tuberculosis-diabetes epidemiology in the border and non-border regions of Tamaulipas, Mexico

Abdelbary, Bassent; García, Juan Ignacio; Ramirez-Oropesa, H.; Rahbar, Mohammad H.; Restrepo, Blanca I.

doi:10.1016/j.tube.2016.09.024

Cited by 39 publications

(61 citation statements)

References 28 publications

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“…However, most data provides support for DM preceding TB. All cohorts to date indicate that DM develops before TB, and those with further characterization of the DM patients suggest that it is not DM in itself, but rather, poorly controlled DM that increases TB risk (14, 27, 28) Cross-sectional studies also support the concept of DM preceding TB, with chronic DM patients (median 7 years) that present other DM complications prior to TB development (18, 20, 29). This highlights the missed opportunities for preventing TB among DM patients who have presumably been in contact for years with their healthcare providers.…”

Section: Epidemiology Of Tb-dmmentioning

confidence: 90%

“…Longitudinal analysis of 163 countries reported increased TB incidence in settings where DM prevalence increased over time (19). In the Mexican state of Tamaulipas, across the border with the US, TB-DM increased by at least 2.8% among TB patients diagnosed between 2006-2013, and this was not explained by higher glucose testing implemented at TB clinics in Mexico (20)(Figure 2). A more remarkable increase of 83% was reported for all Mexican states between 2000-2012.…”

Section: Epidemiology Of Tb-dmmentioning

confidence: 99%

“…Thus, physicians need to be trained in contemporary times to “think TB” when examining patients with pulmonary infections and a “non-classical” socio-demographic profile for TB, in order to avoid delays in TB diagnosis. TB-DM patients (versus TB only) are also more likely to have lower education and higher unemployment, which complicates TB and DM management given that these sociodemograhic factors are associated with less access to healthcare and poorer glucose control (20). …”

Section: Epidemiology Of Tb-dmmentioning

confidence: 99%

“…Some studies show that newly-diagnosed DM patients with TB (versus previously-diagnosed DM) have a different profile: they are more likely to be males, younger patients, and with lower HbA1cs (15, 18, 20). This highlights the importance of TB clinics to reach males who are not as likely to be in contact with the healthcare system when compared to females, or to identify patients who are at an earlier stage of their DM before the presentation of additional and irreversible micro- and macro-vascular complications of DM.…”

Section: Epidemiology Of Tb-dmmentioning

confidence: 99%

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Diabetes and Tuberculosis

2016

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The increase in type 2 diabetes mellitus (DM) patients in countries where tuberculosis (TB) is also endemic has led to the reemerging importance of DM as a risk factor for TB. DM causes a 3-fold increase in TB risk and a 2-fold increase in adverse TB treatment outcomes. Given the sheer numbers of DM patients worldwide, there are now more TB patients with TB-DM comorbidity than TB-HIV coinfection. There is an urgent need to implement strategies for TB prevention and control among the millions of DM patients exposed to Mycobacterium tuberculosis . This chapter summarizes the current epidemiological, clinical, and immunological knowledge on TB and DM and their clinical and public health implications. These include the underlying mechanisms for TB risk in DM patients and their clinical and sociodemographic characteristics that distinguish them from TB patients without DM. TB-DM comorbidity is posing a new challenge for integrating the short-term care for TB with the long-term care for DM, particularly in low- and middle-income countries.

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Section: Epidemiology Of Tb-dmmentioning

confidence: 90%

Section: Epidemiology Of Tb-dmmentioning

confidence: 99%

Section: Epidemiology Of Tb-dmmentioning

confidence: 99%

Section: Epidemiology Of Tb-dmmentioning

confidence: 99%

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Diabetes and Tuberculosis

2016

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“…Furthermore, there is a paucity of studies evaluating the lung, which is the primary site of TB disease, and the relationship between the immune responses to M. tuberculosis in the lung and periphery is poorly understood. Given the higher prevalence of pulmonary (versus extrapulmonary) TB among DM patients,understanding this compartmentalization is particularly relevant 4,23 . Data from the mouse TB-DM model suggest that chronic hyperglycemia exerts unique effects on alveolar versus peritonal and bone marrow-derived macrophages 24 .…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

Defining a Research Agenda to Address the Converging Epidemics of Tuberculosis and Diabetes

Ronacher

Crevel

Critchley

et al. 2017

Chest

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There is growing interest in the re-emerging interaction between type 2 diabetes (DM) and tuberculosis (TB), but the underlying biological mechanisms are poorly understood despite their possible implications in clinical management. Experts in epidemiological, public health, basic science and clinical studies recently convened and identified research priorities for elucidating the underlying mechanisms for the co-ocurrence of TB and DM. We identified gaps in current knowlege of altered immunity in DM patients during TB, where most studies suggest an under-performing innate immunity, but exaggerated adaptive immunity to Mycobacterium tuberculosis. Various molecular mechanisms and pathways that may underly these observations in the DM host. These include signaling induced by excess advanced glycation end products (AGE) and their receptor (RAGE), higher levels of reactive oxidative species and oxidative stress, epigenetic changes due to chronic hyperglycemia, altered nuclear receptors and/or differences in cell metabolism (immuno-metabolism). Studies in humans at different stages of DM (no DM, pre-DM and DM) or TB (latent or active TB) should be complemented with findings in animal models, which provide the unique opportunity to study early events in the host-pathogen interaction. Such studies could also help identify biomarkers that will complement clinical studies in order to tailor the prevention of TB-DM, or avoid the adverse TB treatment outcomes that are more likely in these patients. Such studies will also inform new approaches to host-directed therapies. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT Summary box• Type 2 diabetes is a syndrome characterised by a range of metabolic (e.g. hyperglycemia, hyperlipidemia), inflammatory, vascular and other changes that may all contribute to increasing TB susceptibility and pathology.• Monocytes and macrophages from diabetic patients and mice have defects leading to altered interactions with M. tuberculosis and delayed adaptive immune responses.• Most human studies have been conducted in patients with active TB, where those with TB-DM comorbidity are characterised by increased secretion of Th1, Th17 and Th2 cytokines. However, the few studies in individuals at risk for TB (LTBI) suggest a different cytokine profile.• Molecular pathways that involve AGE/RAGE, ROS, nuclear receptors and cellular metabolism are potential targets for host-directed therapies to reduce TB susceptibility or pathology in DM patients.• Animal models for TB-DM can improve our understanding of underlying mechanisms and effective treatment approaches for the comorbidity of TB and DM. IntroductionType 2 diabetes mellitus (DM) increases the risk of many infectious diseases, including tuberculosis 1 (TB), and it is now recognized that the increasing DM prevalence in high TB incidence countries such as Sub-Saharan Africa (SSA) is a challenge to TB control. 2 The known association between a chronic syndome like DM and an infectious disease like TB requires the near term development...

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

McMurry

Mendenhall

Rajendrakumar

et al. 2018

Diabetes Metabolism Res

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Increasing coprevalence of diabetes mellitus (DM) and tuberculosis (TB) in low-income and middle-income countries (LMICs) indicates a rising threat to the decades of progress made against TB and requires global attention. This systematic review provides a summary of type 2 diabetes and tuberculosis coprevalence in various LMICs. We searched PubMed, Ovid Medline, Embase, and PsychINFO databases for studies that provided estimates of TB-DM coprevalence in LMICs published between 1990 and 2016. Studies that were non-English and exclusively conducted in multidrug resistant-tuberculosis or type 1 diabetes and inpatient settings were excluded. We reviewed 84 studies from 31 countries. There were huge diversity of study designs and diagnostic methods used to estimate coprevalence, and this precluded pooling of the results. Most studies (n = 78) were from small, localized settings. The DM prevalence among TB patients in various LMICs varied from 1.8% to 45%, with the majority (n = 44) between 10% and 30%. The TB prevalence among people with DM ranged from 0.1% to 6.0% with most studies (n = 9) reporting prevalences less than 2%. Coprevalence of TB-DM was higher than general population prevalence of either diseases in these countries. This study underscores the need for intervention and more focused research on TB DM bidirectional screening programs in low-income and middle-income countries as well as integrated chronic disease management.

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Tuberculosis-diabetes epidemiology in the border and non-border regions of Tamaulipas, Mexico

Cited by 39 publications

References 28 publications

Diabetes and Tuberculosis

Diabetes and Tuberculosis

Defining a Research Agenda to Address the Converging Epidemics of Tuberculosis and Diabetes

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

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