Diabetes is a risk factor for pulmonary tuberculosis: a case-control study from Mwanza, Tanzania

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Daniel Faurholt-Jepsen, Nyagosya Range, George PrayGod, Kidola Jeremiah, Maria Faurholt-Jepsen, Martine Grosos Aabye, John Changalucha, Dirk Lund Christensen, Christian Bressen Pipper, Henrik Krarup, Daniel Rinse Witte, Aase Bengård Andersen, Henrik Friis

Background
Diabetes and TB are associated, and diabetes is increasingly common in low-income countries where tuberculosis (TB) is highly endemic. However, the role of diabetes for TB has not been assessed in populations where HIV is prevalent.
Methods
A case-control study was conducted in an urban population in Tanzania among culture-confirmed pulmonary TB patients and non-TB neighbourhood controls. Participants were tested for diabetes according to WHO guidelines and serum concentrations of acute phase reactants were measured. The association between diabetes and TB, and the role of HIV as an effect modifier, were examined using logistic regression. Since blood glucose levels increase during the acute phase response, we adjusted for elevated serum acute phase reactants.
Results
Among 803 cases and 350 controls the mean (SD) age was 34.8 (11.9) and 33.8 (12.0) years, and the prevalence of diabetes was 16.7% (95% CI: 14.2; 19.4) and 9.4% (6.6; 13.0), respectively. Diabetes was associated with TB (OR 2.8, 95% CI: 1.04; 7.67, p=0.04). However, the association depended on HIV status (p=0.01) due to a stronger association among HIV uninfected (OR 4.2, 95% CI: 1.5; 11.6, p=0.01) compared to HIV infected (OR 0.1, 95% CI: 0.01; 1.8, p=0.13) after adjusting for age, sex, demographic factors and elevated serum acute phase reactants.
Conclusion
Diabetes is a risk factor for TB in HIV uninfected, whereas the association in HIV infected patients needs further study. The increasing diabetes prevalence may be a threat to TB control.
OriginalsprogEngelsk
TidsskriftP L o S One
Vol/bind6
Udgave nummer8
Sider (fra-til)e24215
Antal sider5
ISSN1932-6203
DOI
StatusUdgivet - 2011

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