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Diabetes challenges TB control in Europe

More than 10% of patients with tuberculosis enrolled in a study in eight European countries also had diabetes, including more than 28% of TB patients in England, researchers reported.

“Diabetes mellitus represents a challenge for tuberculosis control worldwide and in Europe, especially in foreign-born and in elderly patients,” Monica Sane Schepisi, MD, epidemiologist for the Lazzaro Spallanzani National Institute for Infectious Diseases in Rome, told Infectious Disease News.

Writing in Open Forum Infections Diseases, Schepisi and colleagues noted that diabetes triples the risk for developing TB, changes the way pulmonary TB presents and worsens treatment outcomes. A recent study conducted in the United States found that patients with diabetes who have been diagnosed with TB are more likely to experience a worse prognosis than patients without diabetes.

Schepisi and colleagues conducted a retrospective cross-sectional survey on the prevalence of diabetes among consecutively diagnosed adult patients with TB in 11 TB referral centers in France, Germany, Greece, Italy, Russia, Slovakia, Spain and the United Kingdom between 2007 and 2015. After selecting diabetes-TB cases and TB-only controls, the researchers also performed a case-control analysis that included patients from Norway and Ukraine in addition to patients from the eight other study countries.

According to study findings, the overall prevalence of diabetes in 3,143 patients with TB was 10.7% (95% CI, 9.7-11.9). Greece had the lowest prevalence at 4.4%, whereas the U.K. had the highest, at 28.5%. The median age of patients ranged from 36 to 39 years, and men comprised more than 60% of the patient population in all of the centers. The proportion of foreign-born patients varied across centers, according to the study.

According to Schepisi and colleagues, diabetes was independently associated with older age in the case-control study. Moreover, among older patients in the case-control study, diabetes was also associated with being born in a foreign country. Cavities on chest imaging were more frequently observed among patients with pulmonary involvement and a diagnosis of diabetes, according to the study.

Schepisi and colleagues noted that the prevalence of diabetes in TB patients enrolled in the study was higher than in the general European population, but said that result should be “considered cautiously since the study population was not a random sample of patients diagnosed with TB in countries where the study was carried out.”

“[Older and foreign-born patients] emerged as a vulnerable population, and this suggests that they should be a priority target for TB screening among those with DM,” Schepisi and colleagues wrote. “Further studies to analyze the association of [diabetes] with drug resistance and with TB outcomes, to evaluate whether TB-[diabetes] patients contribute to enhanced TB transmission in low-TB-burden countries, and broader cross-sectional and prospective data that may help in assessing feasibility and cost-effectiveness of TB-diabetes bidirectional screening are needed.”

Schepisi MS, et al. Open Forum Infect Dis. 2018;doi:10.1093/ofid/ofy337.

By Marley Ghizzone


News categories: Tuberculosis