Undiagnosed diabetes mellitus and tuberculosis infection: A population‐based, observational study from eastern China

Li, Qiao; Lü, Peng; Martínez, Leonardo; Peng, Hong; Zhu, Tao; Zhu, Limei; Wang, Jianming; Lü, Wei

doi:10.1002/dmrr.3227

Cited by 14 publications

(6 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…(iiii) Diabetic mice had lower expression of in response to Mycobacterium tuberculosis infection, and Insulin treatment could signi cantly improve the synthesis of Th1-related cytokines which was impaired in diabetic mice with TB infection [31]. Poor glycemic control could also increase the hazard of TB infection [32,33].…”

Section: Discussionmentioning

confidence: 99%

Glycemic Control and the Risk of Tuberculosis: A Population-based Cohort Study

Xia

Ding

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Background: Although diabetes, low body mass index (BMI) and high blood lipid are established risk factors for active tuberculosis, the joint effect of diabetes, BMI and blood lipid is unclear. Methods: We conducted a population-based census in eastern China including 40,311 individuals. We investigated risk factors for incident tuberculosis by excluding tuberculosis at baseline and linking all participants to the Infectious Disease Reporting Management System and Tuberculosis Management Information System of Nanjing City. Follow-up for incident tuberculosis occurred ten years. We matched participants using unique health identity card numbers, name, age, birthdate, and address. We constructed Cox Proportional hazard models adjusting for age, sex, smoking, alcohol use.Results: After ten years follow-up, 143 individuals progressed to tuberculosis. In participants with BMI>24 kg/m2, diagnosed diabetics with fasting blood-glucose (FBG)≥7.0mmol/L showed nearly three-fold increased risk of active TB (HR=3.78, 95%CI: 1.32-10.79, P=0.007), and FBG ≥7.0mmol/L was associated with more than three-fold higher risk of active TB(HR=3.16, 95%CI:1.37-7.28, P=0.007). Among high blood lipid levels, undiagnosed diabetics was related to increase the high risk of TB (HR=3.04, 95%CI: 1.03-8.95, P=0.044) and FBG ≥7.0mmol/L increased nearly two-fold higher risk of TB (HR=2.66, 95%CI: 1.13-6.30, P=0.026). In the linear dose-response analysis, the hazard of TB increased with FBG (with a 1-unit (1-mmol/L) increase in FBG, the hazard of TB increased by 15% (95% CI, 3%–29%). Discussion: In this large population-based cohort study in a medium tuberculosis burden region, we found that diabetes increases the hazard of tuberculosis disease and diabetics with poor glycemic control aggravated this relationship especially in individuals with high level of blood lipid.

show abstract

Section: Discussionmentioning

confidence: 99%

Glycemic Control and the Risk of Tuberculosis: A Population-based Cohort Study

Xia

Ding

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Physical examinations for type 2 diabetes include fasting blood glucose test, height, weight, waist circumference, body temperature, pulse, respiration, and blood pressure. We collected physical examination and anti-tuberculosis treatment outcome data among PLWD tuberculosis patients from the Chinese Tuberculosis Information Management System 12,13 . To further assess tuberculosis among PLWD, we used unique identification numbers from each patient to crossmatch the screening database of the Diabetes Physical Examination System and the Tuberculosis Management Information System.…”

Section: Methodsmentioning

confidence: 99%

A risk score for prediction of poor treatment outcomes among tuberculosis patients with diagnosed diabetes mellitus from eastern China

You

Pan

Zeng

et al. 2021

Sci Rep

Self Cite

View full text Add to dashboard Cite

Persons living with diabetes (PLWD) with newly diagnosed tuberculosis are at greater risk of poor treatment outcomes. Identifying and prioritizing high-risk subgroups of PLWD and tuberculosis for tuberculosis programs to target has been rarely performed. We investigated risk factors for poor tuberculosis treatment outcomes among PLWD and developed a predictive risk score for tuberculosis control prioritization. Among PLWD diagnosed with tuberculosis, demographic, clinical, and tuberculosis treatment outcome data were collected. Poor treatment outcomes included treatment failure, death, default, and transfer. Multivariable logistic regression modeling was used to analyze risk factors of poor treatment outcomes. Risk scores were derived based on regression coefficients to classify participants at low-, intermediate-, and high-risk of poor treatment outcomes. Among 335 PLWD newly diagnosed with tuberculosis, 109 were cured and 172 completed treatment. Multivariable logistic regression found that risk factors of poor treatment outcomes included bacteriologically-positivity, low body mass index, no physical activity, and pulmonary cavitation. Rates of poor treatment outcomes in low- (0–2), intermediate- (3–4), and high-risk (5–8) groups were 4.2%, 10.5%, and 55.4% (Ptrend < 0.0001), respectively. The risk score accurately discriminated poor and successful treatment outcomes (C-statistic, 0.85, 95% CI 0.78–0.91). We derived a simple predictive risk score that accurately distinguished those at high- and low-risk of treatment failure. This score provides a potentially useful tool for tuberculosis control programs in settings with a double burden of both tuberculosis and diabetes.

show abstract

“…LTBI has been found to be twice as prevalent in individuals with diabetes mellitus compared to those without ( Barron et al., 2018 ; Lin et al., 2019 ). In addition, old age and diabetes mellitus are both risk factors for contracting TB and even worse infection outcomes ( Lee et al., 2016 ; Restrepo, 2018 ; Liu et al., 2020 ). This suggests a possible role for metformin in protection against LTBI.…”

Section: Effects Of Existing and Potential Immunomodulators On Pneumo...mentioning

confidence: 99%

Increased susceptibility to pneumonia due to tumour necrosis factor inhibition and prospective immune system rescue via immunotherapy

Keynan

Rueda

2022

Front. Cell. Infect. Microbiol.

View full text Add to dashboard Cite

Immunomodulators such as tumour necrosis factor (TNF) inhibitors are used to treat autoimmune conditions by reducing the magnitude of the innate immune response. Dampened innate responses pose an increased risk of new infections by opportunistic pathogens and reactivation of pre-existing latent infections. The alteration in immune response predisposes to increased severity of infections. TNF inhibitors are used to treat autoimmune conditions such as rheumatoid arthritis, juvenile arthritis, psoriatic arthritis, transplant recipients, and inflammatory bowel disease. The efficacies of immunomodulators are shown to be varied, even among those that target the same pathways. Monoclonal antibody-based TNF inhibitors have been shown to induce stronger immunosuppression when compared to their receptor-based counterparts. The variability in activity also translates to differences in risk for infection, moreover, parallel, or sequential use of immunosuppressive drugs and corticosteroids makes it difficult to accurately attribute the risk of infection to a single immunomodulatory drug. Among recipients of TNF inhibitors, Mycobacterium tuberculosis has been shown to be responsible for 12.5-59% of all infections; Pneumocystis jirovecii has been responsible for 20% of all non-viral infections; and Legionella pneumophila infections occur at 13-21 times the rate of the general population. This review will outline the mechanism of immune modulation caused by TNF inhibitors and how they predispose to infection with a focus on Mycobacterium tuberculosis, Legionella pneumophila, and Pneumocystis jirovecii. This review will then explore and evaluate how other immunomodulators and host-directed treatments influence these infections and the severity of the resulting infection to mitigate or treat TNF inhibitor-associated infections alongside antibiotics.

show abstract

Undiagnosed diabetes mellitus and tuberculosis infection: A population‐based, observational study from eastern China

Cited by 14 publications

References 37 publications

Glycemic Control and the Risk of Tuberculosis: A Population-based Cohort Study

Glycemic Control and the Risk of Tuberculosis: A Population-based Cohort Study

A risk score for prediction of poor treatment outcomes among tuberculosis patients with diagnosed diabetes mellitus from eastern China

Increased susceptibility to pneumonia due to tumour necrosis factor inhibition and prospective immune system rescue via immunotherapy

Contact Info

Product

Resources

About