Increased risk of latent tuberculous infection among persons with pre-diabetes and diabetes mellitus

• Type of Material: Article
• Authors: R. L. Hensel, Emory University; Russell Kempker, Emory University; J. Tapia, Emory University; A. Oladele, DeKalb County Board of Health; Henry Blumberg, Emory University; Matthew Magee, Emory University
• Language: English
• Date: 2016-01-01
• Publisher: International Union Against Tuberculosis and Lung Disease
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2016 The Union.
• Final Published Version (URL): http://dx.doi.org/10.5588/ijtld.15.0457
• Title of Journal or Parent Work: International Journal of Tuberculosis and Lung Disease
• ISSN: 1027-3719
• Volume: 20
• Issue: 1
• Start Page: 71
• End Page: U123
• Grant/Funding Information: This work was supported in part by the National Institute of Health (NIH), National Institute of Allergy and Infectious Diseases, Bethesda, MD (K23AI1030344), and the Atlanta Clinical and Translational Science Institute, Atlanta, GA, USA (NIH/NCATS UL1TR000454).
• Keywords: hemoglobin A1c; MONOCYTES; QuantiFERON test; COHORT; refugee; Science & Technology; Respiratory System; EXPRESSION; Life Sciences & Biomedicine; GAMMA RELEASE ASSAYS; vitamin D; CATHELICIDIN; Infectious Diseases
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology; Biology, Biostatistics

Abstract

SETTING: Although diabetes mellitus (DM) is an established risk factor for active tuberculosis (TB) disease, little is known about the association between pre-DM, DM, and latent tuberculous infection (LTBI). OBJECTIVE: To estimate the association between DM and LTBI. DESIGN: We conducted a cross-sectional study among recently arrived refugees seen at a health clinic in Atlanta, GA, USA, between 2013 and 2014. Patients were screened for DM using glycosylated-hemoglobin (HbA1c), and for LTBI using the QuantiFERONw-TB (QFT) test. HbA1c and QFT results, demographic information, and medical history were abstracted from patient charts. RESULTS: Among 702 included patients, 681 (97.0%) had HbA1c and QFT results. Overall, 54 (7.8%) patients had DM and 235 (33.8%) had pre-DM. LTBI was prevalent in 31.3% of the refugees. LTBI prevalence was significantly higher (P < 0.01) among patients with DM (43.4%) and pre-DM (39.1%) than in those without DM (25.9%). Refugees with DM (adjusted OR [aOR] 2.3, 95%CI 1.2-4.5) and pre-DM (aOR 1.7, 95%CI 1.1-2.4) were more likely to have LTBI than those without DM. CONCLUSION: Refugees with DM or pre-DM from high TB burden countries were more likely to have LTBI than those without DM. Dysglycemia may impair the immune defenses involved in preventing Mycobacterium tuberculosis infection.