Type 2 Diabetes : An Independent Risk Factor for Tuberculosis: A Nationwide Population-Based Study

Abstract

ObjectiveTuberculosis continues to be a major global health problem. We wanted to investigate whether Type 2 diabetes was a risk factor for tuberculosis in an Asian population.MethodsFrom Taiwan’s National Health Insurance Research Database, we collected data from 31,237 female patients with type 2 diabetes and 92,642 female controls and 32,493 male patients with type 2 diabetes and 96,977 male controls. Cox proportional hazard regression was performed to evaluate independent risk factors for tuberculosis in all patients and to identify risk factors in patients with type 2 diabetes.ResultsDuring the study period, both female (standardized incidence ratio (SIR): 1.40, p<0.01) and male (SIR: 1.48, p<0.01) patients with type 2 diabetes were found to have a significantly higher rate of incident tuberculosis than the control group. Type 2 diabetes (HR:1.31, 1.23–1.39, p<0.001) was significantly associated with tuberculosis after adjusting sex, age, bronchiectasis, asthma and chronic obstructive lung disease.ConclusionsPatients with type 2 diabetes have a higher risk of tuberculosis compared to control subjects after adjusting for confounding factors. The current diabetes epidemic may lead to a resurgence of tuberculosis in endemic regions. Therefore, preventive measures, including addressing the possibility that type 2 diabetes increase the individual’s susceptibility for incident TB, should be taken to further reduce the incidence of tuberculosis.

Metformin is associated with a lower risk of active tuberculosis in patients with type 2 diabetes

“…According to a systematic review, among cohort studies, people with DM had an approximately 1.16–7.83 times greater risk of developing TB than did people without DM . Previously, one population‐based study revealed that diabetic Taiwanese patients had a relative risk of 1.3 for developing TB after adjustment for confounding factors . The results of our nationwide population‐based cohort study showed that patients with T2DM are at a significantly higher risk of developing TB after adjusting for confounding factors (aHR: 2.01; 95% CI: 1.80–2.25); our findings are consistent with the findings of previous studies.…”

Diabetes and Tuberculosis

“…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.…”

“…This illustrates the complexity of studying DM as a risk factor for TB given the heterogeneity in DM populations worldwide with respect to their age, access to healthcare, level of glucose control, and the type and number of DM complications and medications. Furthermore, co-ocurrence of DM with other host characteristics can further synergize TB risk among DM patients, as suggested for DM plus smoking, micro and macro-vascular complications of DM, and even their social environment (12-14) This emphasizes the need for studies reporting a thorough characterization of DM and other host factors with multivariable analysis in order to reach reliable conclusions.…”

Risk of active tuberculosis among people with diabetes mellitus: systematic review and meta‐analysis

“…Three large population‐based studies had conducted stratified analysis by ethnicity, country of origin, indigenous status and TB incidence in country of origin. None of these studies showed an effect of these factors modifying the association between DM and TB .…”