The Impact of Diabetes and Prediabetes on Prevalence of Mycobacterium tuberculosis Infection Among Household Contacts of Active Tuberculosis Cases in Ethiopia

• Type of Material: Article
• Authors: Alison G. C. Smith, Emory University; Lance Waller, Emory University; Henry Blumberg, Emory University; Susan Ray, Emory University; Azhar Nizam, Emory University; Jyothi Rengarajan, Emory University; Chris Ibegbu, Emory University; Russell Kempker, Emory University; Neel Gandhi, Emory University; Matthew Magee, Emory University; Toidi Adekambi, Emory University; Lisa Elon, Emory University; Sarita Shah, Emory University; Cheryl Day, Emory University; Sara Auld, Emory University; Jeffrey Collins, Emory University
• Language: English
• Date: 2022-07-01
• Publisher: Oxford Academic
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/ofid/ofac323
• Title of Journal or Parent Work: Open Forum Infectious Diseases
• Volume: 9
• Issue: 7
• Start Page: ofac323
• End Page: ofac323
• Grant/Funding Information: This study was supported in part by the National Institutes of Health (U19 AI111211 and to H. M. B.; UL1 TR002378; TL1 TR002382 to H. M. B., which provided support to A. G. C. S.; K24 AI11444 to N. R. G.; and K23AI134182 to S. C. A.). The study was also supported in part by a Grants for Emerging Researchers/Clinicians Mentorship Program (G.E.R.M.) grant from the Infectious Diseases Society of America (to A. G. C. S.).
• Research Categories: Health Sciences, Public Health

Abstract

Background. It is uncertain whether diabetes affects the risk of developing latent tuberculosis infection (LTBI) following exposure to Mycobacterium tuberculosis (Mtb). We assessed the relationship of diabetes or prediabetes and LTBI among close and household contacts (HHCs) of patients with active pulmonary tuberculosis (TB) disease in Addis Ababa, Ethiopia. Methods. In this cross-sectional study, we performed interferon-γ release assays, TB symptom screening, and point-of-care glycolated hemoglobin (HbA1c) testing among HHCs of active TB cases. Diabetes status was classified into diabetes (HbA1c ≥6.5% or self-reported diagnosis), prediabetes (5.7%-6.4%), and euglycemia (≤5.6%). Multivariable logistic regression was used to determine the association of diabetes with LTBI. Results. Among 597 study participants, 123 (21%) had dysglycemia including diabetes (n = 31) or prediabetes (n = 92); 423 (71%) participants were diagnosed with LTBI. Twelve of 31 (39%) HHCs with diabetes were previously undiagnosed with diabetes. The prevalence of LTBI among HHCs with diabetes, prediabetes, and euglycemia was 87% (27/31), 73% (67/92), and 69% (329/474), respectively. In multivariable analysis adjusted for age, sex, and HIV status, the odds of LTBI among HHCs with diabetes were 2.33 (95% confidence interval [CI], .76-7.08) times the odds of LTBI without diabetes. When assessing interaction with age, the association of diabetes and LTBI was robust among participants aged ≥40 years (adjusted odds ratio [aOR], 3.68 [95% CI, .77-17.6]) but not those <40 years (aOR, 1.15 [95% CI, .22-6.1]). Conclusions. HHCs with diabetes may be more likely to have LTBI than those with euglycemia. Further investigations are needed to assess mechanisms by which diabetes may increase risk of LTBI after Mtb exposure.