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. 2022 Nov 17:10:1017024.
doi: 10.3389/fpubh.2022.1017024. eCollection 2022.

Glycemic control and the risk of tuberculosis in patients with diabetes: A cohort study in a Mediterranean city

Violeta Antonio-Arques  1   2 , Joan A Caylà  3 , Jordi Real  1   4 , Antonio Moreno-Martinez  5   6 , Àngels Orcau  6   7 , Didac Mauricio  1   4   8   9 , Manel Mata-Cases  1   4   10 , Josep Julve  4   11 , Elena Navas Mendez  12 , Rai Puig Treserra  1 , Joan Pau Millet  6   7 , Jose Luis Del Val García  12   13 , Bogdan Vlacho  1 , Josep Franch-Nadal  1   4   14
Affiliations

Glycemic control and the risk of tuberculosis in patients with diabetes: A cohort study in a Mediterranean city

Violeta Antonio-Arques et al. Front Public Health. .

Abstract

Background: Diabetes mellitus (DM) is one of the leading chronic diseases globally and one of the most common causes of death, morbidity, and poor quality of life. According to the WHO, DM is also one of the main risk factors for developing active tuberculosis (TB). Subjects with DM are at a higher risk of infections, in addition to frequent micro and macrovascular complications, and therefore sought to determine whether poor glycemic control is linked to a higher risk of developing TB.

Methods: We used a retrospective cohort of diabetic subjects to predict the incidence of TB. All DM patients were recruited from Ciutat Vella (the inner-city of Barcelona) from January 2007 until December 2016, with a follow-up period until December 2018 (≥2 years). Data were extracted from Barcelona's Primary Care medical record database - SIDIAP, and linked to the Barcelona TB Control Program. The incidence of TB and the impact of glycemic control were estimated using time-to-event curves analyzed by Cox proportional hazard regression. Hazard ratios (HRs) and 95% confidence intervals (CIs), unadjusted and adjusted by potential confounding variables, were also assessed, which included age, sex, diabetes duration, macrovascular and microvascular signs, BMI, smoking habit, alcohol consumption and geographical origin.

Results: Of 8,004 DM patients considered for the study (equating to 68,605 person-years of follow-up), 84 developed TB [incidence rate = 70 (95% CI: 52-93) per 100,000 person-years]. DM subjects with TB were younger (mean: 52.2 vs. 57.7 years old), had higher values of glycosylated hemoglobin (HbA1c) (7.66 vs. 7.41%) and total triglycerides (122 vs. 105 mg/dl), and had twice the frequency of diabetic nephropathy (2.08 vs. 1.18%). The calculated incidence rate increased with increasing HbA1c: 120.5 (95% CI 77.2-179.3) for HbA1c ≥ 7.5%, 143 (95% CI 88.3-218.1) for HbA1c ≥ 8% and 183.8 (95% CI 105-298) for HbA1c ≥ 9%. An increase in the risk of TB was also observed according to a poorer optimization of glycemic control: adjusted HR 1.80 (95% CI 0.60-5.42), 2.06 (95% CI 0.67-6.32), and 2.82 (95% CI 0.88-9.06), respectively.

Conclusion: Diabetic subjects with worse glycemic control show a trend toward a higher risk of developing TB.

Keywords: Primary Health Care; comorbidities; diabetes complications; diabetes mellitus; glycemic control; social determinants of health; tuberculosis.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the DM cohort within the study population.
Figure 2
Figure 2
Cumulative incidence per 100,000 person-year of TB according to HbA1c level.
Figure 3
Figure 3
Forest plot of the factors associated with DM that can influence the appearance of TB.
See this image and copyright information in PMC

References

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