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Effect of diabetes mellitus on risk of latent TB infection in a high TB incidence area: a community-based study in Taiwan.

ABSTRACT: OBJECTIVE:To investigate the association between diabetes and latent tuberculosis infections (LTBI) in high TB incidence areas. DESIGN:Community-based comparison study. SETTING:Outpatient diabetes clinics at 4 hospitals and 13 health centres in urban and rural townships. A community-based screening programme was used to recruit non-diabetic participants. PARTICIPANTS:A total of 2948 patients with diabetes aged older than 40 years were recruited, and 453 non-diabetic participants from the community were enrolled. PRIMARY AND SECONDARY OUTCOME MEASURES:The interferon-gamma release assay (IGRA) and the tuberculin skin test were used to detect LTBI. The IGRA result was used as a surrogate of LTBI in logistic regression analysis. RESULTS:Diabetes was significantly associated with LTBI (adjusted OR (aOR)=1.59; 95%?CI 1.11 to 2.28) and age correlated positively with LTBI. Many subjects with diabetes also had additional risk factors (current smokers (aOR=1.28; 95%?CI 0.95 to 1.71), comorbid chronic kidney disease (aOR=1.26; 95%?CI 1.03 to 1.55) and history of TB (aOR=2.08; 95%?CI 1.19 to 3.63)). The presence of BCG scar was protective (aOR=0.66; 95%?CI 0.51 to 0.85). Duration of diabetes and poor glycaemic control were unrelated to the risk of LTBI. CONCLUSION:There was a moderately increased risk of LTBI in patients with diabetes from this high TB incidence area. This finding suggests LTBI screening for the diabetics be combined with other risk factors and comorbidities of TB to better identify high-risk groups and improve the efficacy of targeted screening for LTBI.

SUBMITTER: Lin CH

PROVIDER: S-EPMC6830704 | biostudies-literature | 2019 Oct

REPOSITORIES: biostudies-literature

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Effect of diabetes mellitus on risk of latent TB infection in a high TB incidence area: a community-based study in Taiwan.

Lin Ching-Hsiung CH Kuo Shu-Chen SC Hsieh Ming-Chia MC Ho Shang-Yun SY Su Ih-Jen IJ Lin Sheng-Hao SH Chi Chia-Yu CY Su Shih-Li SL Liao Chiung-Ying CY Chen Yee-Chun YC Hsu Shang-Ren SR Huang Yuan-Chun YC Tseng Fan-Chen FC Wang Shu Yi SY Dou Horng Yunn HY Lin Shi-Dou SD Lin Jen-Shiou JS Tu Shih-Te ST Yeh Yen-Po YP

BMJ open 20191028 10

<h4>Objective</h4>To investigate the association between diabetes and latent tuberculosis infections (LTBI) in high TB incidence areas.<h4>Design</h4>Community-based comparison study.<h4>Setting</h4>Outpatient diabetes clinics at 4 hospitals and 13 health centres in urban and rural townships. A community-based screening programme was used to recruit non-diabetic participants.<h4>Participants</h4>A total of 2948 patients with diabetes aged older than 40 years were recruited, and 453 non-diabetic ...[more]

PMID: 31662365

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Project description:BackgroundPrevention of TB is paramount to achieving elimination targets as recommended by the World Health Organization's action framework for low incidence countries striving to eliminate TB. Although the rates of TB in Canada are low, understanding the latent TB infection (LTBI) cascade is paramount to identifying gaps in care and treatment barriers, thereby increasing the effectiveness of preventive strategies. The purpose of this study was to examine the LTBI cascade of care and identify barriers to treatment completion in adults referred from primary care to a regional tertiary care TB clinic in Ottawa, Canada.MethodsElectronic medical records between January 2010 and December 2016 were reviewed retrospectively and an LTBI cascade of care was constructed from The Ottawa Hospital TB clinic and surrounding primary care clinics. A cohort of 2207 patients with untreated LTBI was used to ascertain the associations between demographic and clinical factors for both treatment non-initiation and non-completion using log-binomial univariable and multivariable regression models.ResultsOf 2207 patients with untreated LTBI who were seen in the clinic during the study period, 1771 (80.2%) were offered treatment, 1203 (67.9% of those offered) started treatment, and 795 (66.1% of those started) completed treatment. In multivariable analysis, non-initiation of treatment was associated with older age (adjusted risk ratio [aRR] 1.06 per 5-year increase, 95% CI: 1.03-1.08) and female gender (aRR 1.28, 95% CI: 1.11-1.47). Non completion of treatment was associated with referral from the TB Clinic back to the primary care team following initial consult (aRR 1.62, 95% CI: 1.35-1.94) and treatment with the standard of 9 months of Isoniazid (9H) compared to 4 months of Rifampin (4R) (aRR 1.45, 95% CI:1.20-1.74).ConclusionsLTBI treatment completion was significantly decreased among patients who were referred back to primary care from the TB clinic. The 4R regimen resulted in more people completing LTBI treatment compared to 9H in keeping with a recently published RCT. Improved education, communication, and collaboration between tertiary care TB clinics and primary care teams may improve treatment completion rates and address the TB burden in low incidence communities in Canada.

Dataset Information

Effect of diabetes mellitus on risk of latent TB infection in a high TB incidence area: a community-based study in Taiwan.

Publications

Effect of diabetes mellitus on risk of latent TB infection in a high TB incidence area: a community-based study in Taiwan.

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