Burden and Characteristics of the Comorbidity Tuberculosis—Diabetes in Europe: TBnet Prevalence Survey and Case-Control Study

Abstract

BackgroundThe growing burden of diabetes mellitus (DM) is posing a threat to global tuberculosis (TB) control. DM triples the risk of developing TB, modifies the presenting features of pulmonary TB, and worsens TB treatment outcomes. We aimed to analyze the prevalence of DM among TB patients and to describe the characteristics and clinical presentation of TB-DM patients in Europe.MethodsWe performed a cross-sectional survey on the prevalence of DM among consecutively diagnosed adult TB patients in 11 European TB referral centers located in France, Germany, Greece, Italy, Russia, Slovakia, Spain, and the United Kingdom over the period 2007–2015. We also selected DM-TB cases and TB only controls with a 1:3 ratio to perform a case-control analysis, including patients selected from the countries mentioned above plus Norway and Ukraine.ResultsAmong 3143 TB enrolled patients, DM prevalence overall was 10.7% and ranged from 4.4% in Greece to 28.5% in the United Kingdom. Patients’ median ages ranged from 36 to 49 years, and all centers had >60% males; the proportion of foreign-born patients varied widely across sites. In the case-control study, DM was independently associated with older age and, among older patients, with being foreign-born. Among patients with pulmonary involvement, cavities on chest imaging were more frequently observed among those with DM.ConclusionsDiabetes mellitus represents a challenge for TB control in Europe, especially in foreign-born and in elderly patients. Specific screening strategies should be evaluated.

Diabetes-associated Susceptibility to Tuberculosis: Contribution of Hyperglycemia vs. Dyslipidemia

“…TB patients with T2D frequently have more severe disease on chest X-ray at diagnosis with more cavities and parenchymal lesions [25,26]. Bilateral pulmonary involvement and extensive pulmonary disease was also found on CT scans in TB patients with underlying T2D [27,28].…”

Immigrants and tuberculosis in Europe – are we prepared for outbreak?

“…In 2015, 60,195 cases of TB were reported in the European Union (EU) and the European Economic Area (EEA) Member States, with the notification rate of 11.7 per 100,000 population (with the exception of Lichtenstein, which did not provide any data), but 17,913 patients (29.8%) were born outside the reporting country [12]. In 2016, estimated 290,000 new TB cases and relapses occurred in the European Region countries, an equivalent of 31.6 cases per 100,000 population [13].…”

Tuberculosis and Non-Communicable Disease Multimorbidity: An Analysis of the World Health Survey in 48 Low- and Middle-Income Countries

“…Despite this, evidence on NCD multimorbidity in people with TB in these areas remains scarce, with numerous gaps and limitations in the literature. First, most research considering TB multimorbidity—presence of TB alongside one or more chronic conditions—has included small-scale studies [ 26 ], been restricted to a single country [ 4 , 27 , 28 ], or only considered one comorbid chronic condition [ 29 , 30 ]. Second, limited information is available on the actual patterns and risks of multimorbidity compared to the general population and on the burden of disease associated with TB multimorbidity [ 31 ].…”