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Exp Clin Endocrinol Diabetes 2014; 122(09): 528-532
DOI: 10.1055/s-0034-1377044
Article
© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

Latent Tuberculosis in Patients with Diabetes Mellitus: Prevalence, Progression and Public Health Implications

M. K. S. Leow
1   Senior Consultant, Department of Endocrinology, Tan Tock Seng Hospital
,
R. Dalan
2   Consultant, Department of Endocrinology, Tan Tock Seng Hospital
,
C. B. E. Chee
3   Senior Consultant, Tuberculosis Control Unit, Tan Tock Seng Hospital
,
A. Earnest
4   Associate Professor, Centre for Quantitative Medicine, Duke-NUS Graduate Medical School
,
D. E. K. Chew
2   Consultant, Department of Endocrinology, Tan Tock Seng Hospital
,
A. W. K. Tan
2   Consultant, Department of Endocrinology, Tan Tock Seng Hospital
,
W. Y. C. Kon
1   Senior Consultant, Department of Endocrinology, Tan Tock Seng Hospital
,
M. Jong
1   Senior Consultant, Department of Endocrinology, Tan Tock Seng Hospital
,
T. Barkham
5   Senior Consultant, Clinical Microbiology, Laboratory Medicine, Tan Tock Seng Hospital
,
Y. T. Wang
3   Senior Consultant, Tuberculosis Control Unit, Tan Tock Seng Hospital
› Author Affiliations
Further Information

Publication History

received 04 February 2014
first decision 23 April 2014

accepted 21 May 2014

Publication Date:
08 July 2014 (online)

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Abstract

Background: Diabetes mellitus (DM) confers a higher risk for tuberculosis (TB). Yet, TB screening and chemoprophylaxis for latent TB infection (LTBI) in DM remains controversial. We conducted a cross-sectional study to elucidate LTBI prevalence and longitudinal follow-up to ascertain LTBI to active TB progression rate in DM.

Methods: 220 DM patients without previous TB from the outpatient diabetes clinic of the hospital were enrolled. T-Spot TB, tuberculin-skin-test (TST) and chest radiography (CXR) were performed. LTBI was defined by negative CXR with reactive T-Spot TB. Progression to active TB was confirmed by cross-checking against the TB registry.

Results: The prevalence of LTBI was 28.2% (62/220) by reactive T-Spot. None progressed to active TB from 2007–2013. Multivariate analysis revealed that any co-morbidity (p=0.016) was positively associated while metformin (p=0.008) was negatively associated with LTBI.

Conclusions: Over a quarter of DM patients harbor LTBI. While the lack of demonstrable progression to active TB within the follow-up time frame up to this point does not unequivocally support a routine TB screening policy or anti-TB chemoprophylaxis for LTBI in a diabetic population for now, this preliminary evidence needs re-evaluation with longer follow-up of this enrolled cohort over the next decade.

Key words

diabetes - diagnosis - infectious diseases - tuberculosis - screening - Prophylaxis

Supplementary Material

 

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