PREVALENCE OF LATENT TUBERCULOSIS IN DIABETIC AND NON-DIABETIC INDIVIDUALS IN A TERTIARY CARE CENTER: A COMPARATIVE STUDY

ROHAN KADAM; SUDEEP KUMAR; TUSHAR KANAWADE; JOSHI RS

doi:10.22159/ajpcr.2023.v16i12.49953

Authors

ROHAN KADAM Department of General Medicine, Maharashtra Institute of Medical Education and Research, Pune, Maharashtra, India,
SUDEEP KUMAR Department of General Medicine, Maharashtra Institute of Medical Education and Research, Pune, Maharashtra, India,
TUSHAR KANAWADE Director and Consultant Physician, Platinum Hospital, Nashik, Maharashtra, India.
JOSHI RS Department of General Medicine, Maharashtra Institute of Medical Education and Research, Pune, Maharashtra, India,

DOI:

https://doi.org/10.22159/ajpcr.2023.v16i12.49953

Keywords:

Diabetes mellitus, Latent tuberculous infection, HbA1c, Tuberculin test

Abstract

Objectives: The aims of this study were as follows: (1) To study the prevalence of latent tuberculosis (TB) in diabetic and non-diabetic population attending the tertiary care hospital. (2) To investigate the association between diabetes mellitus (DM) and latent TB, evaluating the prevalence of positive tuberculin tests and assessing glycemic parameters in diabetic patients with latent TB.

Methods: This was a single-center, hospital-based, observational, and comparative study conducted in the department of general medicine of a tertiary care medical college. One hundred and thirty-six diabetic patients of either gender or 137 healthy individuals acting as control group were included in this study on the basis of a predefined inclusion and exclusion criteria. Patients were evaluated by detailed history and clinical examination. The diagnosis of latent TB was based on a positive tuberculin test without any clinical features of active TB. The prevalence of latent TB infection was compared in both the groups. p<0.05 was taken as statistically significant.

Results: Patients in both the groups were found to be comparable in terms of gender distribution and mean age. Predominant patients were found to have type 2 DM. The mean duration of DM was noted to be 91.58±60.68 months. The most common diagnoses of patients in non-diabetes group were COVID-19 (9.49%), neurological diseases (8.76%), infections (7.3%), acute myocardial infarction (6.57%), and iron deficiency anemia (5.84%). About 21.32% of cases in DM group were noted to have latent TB, while the proportion of latent TB was noted to be 7.30% in the non-diabetes group. The mean fasting blood sugar, mean post-prandial blood sugar, as well as mean HbA1c were significantly higher (p<0.05) in the subgroup with latent TB versus the subgroup without latent TB.

Conclusion: Individuals with diabetes mellitus were found to have increased risk of latent TB infection. In addition, male gender and elevated glycemic parameters were found to be key factors associated with latent tuberculous infection in diabetes.

Downloads

Download data is not yet available.

References

Tepekule B, Kusejko K, Zeeb M, Tarr PE, Calmy A, Battegay M, et al. Impact of latent tuberculosis on diabetes. J Infect Dis 2022;225:2229-34. doi:10.1093/infdis/jiac054

Ngo MD, Bartlett S, Ronacher K. Diabetes-associated susceptibility to tuberculosis: Contribution of hyperglycemia vs. dyslipidemia. Microorganisms 2021;9:2282. doi:10.3390/microorganisms9112282

Bisht MK, Dahiya P, Ghosh S, Mukhopadhyay S. The cause-effect relation of tuberculosis on incidence of diabetes mellitus. Front Cell Infect Microbiol 2023;13:1134036. doi:10.3389/fcimb.2023.1134036

Ayelign B, Negash M, Genetu M, Wondmagegn T, Shibabaw T. Immunological impacts of diabetes on the susceptibility of Mycobacterium tuberculosis. J Immunol Res 2019;2019:6196532. doi:10.1155/2019/6196532

Nissapatorn V, Kuppusamy I, Anuar AK, Quek KF, Latt HM. Tuberculosis: Clinical manifestations and outcomes. Southeast Asian J Trop Med Public Health 2003;34 (Suppl 2):147-52.

Monedero-Recuero I, Gegia M, Wares DF, Chadha SS, Mirzayev F. Situational analysis of 10 countries with a high burden of drug-resistant tuberculosis 2 years post-UNHLM declaration: Progress and setbacks in a changing landscape. Int J Infect Dis 2021;108:557-67. doi:10.1016/j. ijid.2021.06.022

Damadarosamy K, Selvaraj H, Padmashree L, Harsha R, Sasankan AS, Thangavelu P, et al. Diabetes and TB: Confluence of two epidemic and its effect on clinical presentation. Curr Diabetes Rev 2023. doi:10.2174/1573399819666230331113156

Al-Rifai RH, Pearson F, Critchley JA, Abu-Raddad LJ. Association between diabetes mellitus and active tuberculosis: A systematic review and meta-analysis. PLoS One 2017;12:e0187967. doi:10.1371/journal. pone.0187967

Segura-Cerda CA, López-Romero W, Flores-Valdez MA. Changes in host response to Mycobacterium tuberculosis infection associated with type 2 diabetes: Beyond hyperglycemia. Front Cell Infect Microbiol 2019;9:342. doi:10.3389/fcimb.2019.00342

Torres AV, Corrêa RD, Bevilacqua MF, França do Prado LC, de Constantino Bandeira FM, Rodrigues LS, et al. Screening of latent tuberculosis infection among patients with diabetes mellitus from a high-burden area in Brazil. Front Clin Diabetes Healthc 2022;3:914574. doi:10.3389/fcdhc.2022.914574

Salindri AD, Haw JS, Amere GA, Alese JT, Umpierrez GE, Magee MJ. Latent tuberculosis infection among patients with and without type-2 diabetes mellitus: Results from a hospital case-control study in Atlanta. BMC Res Notes 2021;14:252.

Cohen A, Mathiasen VD, Schön T, Wejse C. The global prevalence of latent tuberculosis: A systematic review and meta-analysis. Eur Respir J 2019;54:1900655. doi:10.1183/13993003.00655-2019

Hensel RL, Kempker RR, Tapia J, Oladele A, Blumberg HM, Magee MJ. Increased risk of latent tuberculous infection among persons with pre-diabetes and diabetes mellitus. Int J Tuberc Lung Dis 2016;20:71-8.

Ping PA, Zakaria R, Islam MA, Yaacob LH, Muhamad R, Wan Mohamad WM, et al. Prevalence and risk factors of latent tuberculosis infection (LTBI) in patients with type 2 diabetes mellitus (T2DM). Int J Environ Res Public Health 2021;18:305.

Bhattacharyya R, Shukla M, Nagra S, Banerjee D. Insights from the computational analysis of CD271 glycation in mescenchymal stem cells in diabetes mellitus as a predisposition to latent tuberculosis. Bioinformation 2013;9:829-31.

Magee MJ, Salindri AD, Kornfeld H, Singhal A. Reduced prevalence of latent tuberculosis infection in diabetes patients using metformin and statins. Eur Respir J 2019;53:1801695.

Sutter A, Landis D, Nugent K. The potential role for metformin in the prevention and treatment of tuberculosis. J Thorac Dis 2022;14:1758-65. doi:10.21037/jtd-22-39

Zhou G, Guo X, Cai S, Zhang Y, Zhou Y, Long R, et al. Diabetes mellitus and latent tuberculosis infection: An updated meta-analysis and systematic review. BMC Infect Dis 2023;23:770. doi:10.1186/ s12879-023-08775-y

Lee MR, Huang YP, Kuo YT, Luo CH, Shih YH, Shu CC, et al. Diabetes mellitus and latent tuberculosis infection: A systematic review and metaanalysis. [published correction appears in Clin Infect Dis 2017;65:356]. Clin Infect Dis 2017;64:719-27. doi:10.1093/cid/ciw836

Lin CH, Kuo SC, Hsieh MC, Ho SY, Su IJ, Lin SH, et al. Effect of diabetes mellitus on risk of latent TB infection in a high TB incidence area: A community-based study in Taiwan. BMJ Open 2019;9:e029948. doi:10.1136/bmjopen-2019-029948