INT J TUBERC LUNG DIS 19(12):15071512

Q 2015 The Union

http://dx.doi.org/10.5588/ijtld.15.0102
Factors associated with diabetes mellitus among adults with tuberculosis in a large European
city, 20002013
A. MorenoMartnez,*

<

M.
Casals,*

<`
<
P. Gorrindo,* E. Masdeu,* J. A.
A.
Cayla;*`
Orcau,*

<

and the
TB

Diabetes Working Group of the Barcelona TB Investigation Unit

*Epidemiology Service, Agencia` de Salut Publica de Barcelona, Barcelona, <Biomedical
Research Consortium of the Epidemiology and Public Health Network (CIBERESP),
Barcelona, Spain
B A C K G R O U N D : Diabetes mellitus (DM) can contribute to the development of
tuberculosis (TB).
O B J E C T I V E : To analyse the prevalence of DM and its associated factors among adults
with TB in a large city in an industrialised country.
M E T H O D S : This is a population-based study in adults diagnosed with TB between 2000
and 2013 in Barce- lona. We studied potentially associated sociodemo- graphic and
clinical/epidemiological factors. Logistic regression was used to calculate odds ratios (ORs)
and their 95% confidence intervals (CIs).
R E S U LT S : Of 5849 TB patients, 349 (5.9%) had DM. The annual prevalence of DM
ranged from 4.0% to 7.2%. Factors associated with DM were being Spanish- born (OR 1.46,
95%CI 1.111.96), age 740 years (OR 6.08, 95%CI 4.368.66), cavitary patterns on chest XS U M M AR Y
ray (OR 1.42, 95%CI 1.081.86), experiencing more side effects due to anti-tuberculosis
treatment (OR 1.86, 95%CI 1.282.64) and hospitalisation at the time of diagnosis (OR 1.8,
95%CI 1.402.31). Human immu- nodeficiency virus infection was associated with a lower
probability of DM in both subjects with a history of injection drug use (OR 0.27, 95%CI
0.100.57) and those without (OR 0.04, 95%CI 0.0020.19).
C O N C L U S I O N S : DM prevalence among adults with TB in Barcelona is low and
remained stable over the 14-year study period. However, TB patients with DM were
potentially more infectious and their clinical manage- ment was more complicated.
K E Y W O R D S : age; HIV infection; injection drug users; side effects; cavitary pattern
THE INTERNATIONAL DIABETES Federation estimated that by 2011 over 366 million
people aged 2079 years, representing 8.3% of the worlds population, would have diabetes
mellitus (DM). It is expected that by 2030, DM will become the seventh greatest cause of
death worldwide.1
The association between DM and tuberculosis (TB) is well known.2 However, the dramatic
increase in obesity and DM in recent decades, particularly in some low-income, high TB
prevalence areas of Asia such as India and China, has led to more extensive analyses of this
association.3,4 Although some studies have shown that the risk of DM patients acquiring TB
is up to three times higher than among non- diabetics,3 and even higher among insulindependent cases,5 prevalence is variable. DM prevalence among TB cases ranges from
around 50%, reported by some studies in India, to under 10% in parts of the United States, or
even lower in certain African countries, with nearly 30% prevalence in Mexico.2,4,610 In
Spain, according to official statistics, DM prevalence

was 6.4% in 2009 among the general population aged .16 years, and has been rising since
1993.
A recent population-based study showed a DM prevalence in adults of 13.8%, with
approximately 6% of cases remaining undiagnosed.11 In Barcelona, DM prevalence among
TB cases in 2013 was 6.6%. The increasing prevalence is related to an aging population, low
income levels, changes in lifestyles, obesity and improvements in diagnosis and notification,12 changes that are occurring ever more rapidly in low- and middle-income countries.13
Our hypoth- esis was that the epidemiological profile of industri- alised countries is different
from that of low-income countries due to better monitoring and control of DM.
The present study aimed to assess the relationship between DM and TB in an industrialised
country with an intermediate TB burden and to help establish priorities for epidemiological
control of both diseas- es, as suggested by other authors.2,3,6,14,15 The study also aimed to
analyse the evolution of DM prevalence and identify associated factors among adults with TB
Correspondence to: Antonio Moreno-Martnez, Epidemiology Service, Agencia` de Salut
Publica de Barcelona, Barcelona, Spain. Tel: (34) 932 384 555. Fax: (34) 932 182 275. email: amoreno@aspb.cat
Article submitted 29 January 2015. Final version accepted 28 June 2015.

1508 The International Journal of Tuberculosis and Lung Disease

Figure Trend and evolution of the percentage of diabetes mellitus cases among adults with
tuberculosis by year of diagnosis. Barcelona, 20002013. Line trend P 0,351.
in Barcelona, north eastern Spain (population 1.6 million16 and TB incidence, 20 per 100
000 popula- tion).17
MATERIAL AND METHODS
Study design
This was a retrospective, population-based, cross- sectional study conducted in the city of
Barcelona.

Subjects
All cases aged 718 years diagnosed with active TB between 1 January 2000 and 31 December
2013, residing in Barcelona and detected by the Programme for Prevention and Control of
Tuberculosis of Barcelona (PPCTB), were included in the study.
Variables
We analysed sociodemographic, clinical and treat- ment data that had been collected
systematically using PPCTB epidemiological questionnaires routine- ly administered by
nursing personnel of the Barcelona Public Health Agency (Agencia` de Salut Publica de
Barcelona, ASPB) Epidemiology Service and their evolution.
Definitions
A diagnosis of DM was based on information provided by the patient, recorded in medical
charts and systematically reviewed by public health person- nel and/or fasting plasma glucose
.126 mg/dl.18 TB cases were defined in accordance with epidemiolog- ical criteria. A TB
patient was defined as anyone who had been prescribed and had received anti-tubercu- losis
treatment, except for those who had died or defaulted from treatment due to side effects.
Diag- nosed TB cases were classified according to the European Surveillance Network
criteria: a possible TB case was defined as a subject who met the clinical criteria for TB; a
probable case as one who met clinical criteria for TB, and was also smear-positive or
presented granulomas on histological testing, or was positive on a nucleic acid amplification
test (NAAT); a confirmed TB case was defined as a case who, in addition to being smearpositive, was also culture- or NAAT-positive.19 Subjects were considered to have multidrugresistant TB (MDR-TB) if their strains were resistant to at least isoniazid (INH) and
rifampicin (RMP), or extensively drug-resistant TB when, in addition to MDR-TB, they were
also resistant to all fluoroquinolones and at least one of the three injectable second-line drugs.
Cases with non-tuberculous mycobacteria were excluded.
Statistical analysis
We conducted a descriptive study to calculate DM prevalence among the patients included.
We also calculated frequency distributions for qualitative variables, and measures of central
tendency and precision for quantitative variables. Potential factors associated with DM were
analysed at bivariate level by comparing proportions between groups using the v2 test. At
multivariate level, we fitted a logistic regression model using the stepwise-selection method
and included those factors found to be associated at bivariate level with P , 0.1. We calculated
odds ratios (ORs) and their associated 95% confidence intervals (CIs). Model fit was assessed
using the Hosmer-Lemeshow test. In all analyses, P , 0.05 was considered statistically
significant. Analyses were performed using IBM Statistical Package for the Social Sciences
Statistics, version 19 (IBM Corp, Armonk, NY, USA) and the compareGroups package of the
R statistical system (R Computing, Vienna, Austria). DM trends were obtained using the
classical v2 test for trends in proportions (as implemented in the R function prop.trend.test).
Ethical considerations

As the data were obtained from questionnaires administered by ASPB Epidemiology Service
nursing personnel as part of routine monitoring of notifiable diseases, ethics approval was not
considered neces- sary, and subjects were not required to provide informed consent. Data
were processed anonymous- ly, respecting strict confidentiality in accordance with the ethics
principles of the 1964 Helsinki Declaration (revised in 2000 by the World Medical
Association) and in accordance with the 1999 Spanish Data Protection Act.
RESULTS
Of the 5849 adult TB patients included in the study, 349 (5.97%) had DM. The proportion
with DM among the included patients rose slightly over the 14- year study period, from 6.2%
in 2000 to 6.7% in 2013 (P 0.351) (Figure). The median age of the DM patients was 63
years (Quartile [Q] 1 50, Q3 74);

DM among adults with TB 1509

237 (67.9%) were male and 275 (78.8%) were Spanish-born; 87.4% were aged 740 years,
71.6% presented with pulmonary TB, and 14.6% died during anti-tuberculosis treatment.
At bivariate level, factors associated with DM were being Spanish-born, previous
immunosuppressive treatment, age 740 years, death during anti-tuber- culosis treatment, more
adverse effects due to anti- tuberculosis drugs, hospitalisation and cavitation on chest X-ray
(CXR). Human immunodeficiency virus (HIV) infection was associated with a low
probability of DM in both subjects with and those without a history of injection drug use
(IDU). In contrast, no differences were found with regard to any of the following: year of TB
diagnosis (5.8% during 1999 2006 vs. 6.2% during 20072013), type of TB case (new or
relapse/reinfection), history of incarceration, susceptibility of isolated strains to INH or RMP,
presence of MDR-TB strains, or microbiological confirmation in pulmonary forms of TB
(Table).
Multivariate analysis confirmed the association between DM and being Spanish-born, age
740 years, having more adverse effects to anti-tuberculosis drugs, cavitation on CXR and
requiring hospitalisa- tion. HIV infection was associated with a lower probability of DM,
regardless of history of IDU (Table).
DISCUSSION
The study shows that DM prevalence in Barcelona among adults diagnosed with TB has
remained stable since 2000, with an average prevalence during the period of 6%. Having DM
is associated with being Spanish-born, age 740 years, cavitation on CXR, having more
adverse effects on anti-tuberculosis treatment and requiring hospitalisation at the time of
diagnosis. HIV infection was associated with a low probability of DM, regardless of history
of IDU. Although a higher proportion of DM than non-DM subjects died during antituberculosis treatment, this difference was not statistically significant at multi- variate level.
Despite the increasing worldwide trend in DM,1 DM prevalence among TB patients varies
consider- ably between countries, depending on economic, demographic, geographic and
epidemiological fac- tors, and ranging from slightly over 4% to around 50%.4,68,20 This

study found that DM prevalence among adult TB patients in Barcelona had remained stable
in recent years. The prevalence observed in 2013 was similar to the estimate for the general
population, between 4.8% and 18.7%,15 and lower than the 13.8% observed in a populationbased survey conducted in Spain.11 In 2006, however, a study carried out in Madrid among
the TB population aged .64 years concluded that DM was the second greatest risk factor for
TB, with a prevalence of
12.3%.21 Other chronic health-affecting behaviour, such as smoking, or new treatment
regimens using immunosuppressors, have also been identified as risk factors for the
development of TB.21,22 This study found no differences on multivariate analysis, al- though
immunosuppressive treatment was more common among adults with DM, and no differences
were found on the basis of smoking, homelessness, or history of incarceration or of previous
TB.
One of the factors found to be associated with DM among TB patients included being
Spanish-born. Differences between the Spanish-born (8.1%) and the immigrant population
(3%) may be due to the lower prevalence of overweight subjects and perhaps also lower DM
prevalence among immigrants, who tend to be younger than native Spaniards with TB.12,13
According to Spains National Health System Strategy for DM (Estrategia en Diabetes del
Sistema Nacional de Salud), DM, especially type 2 DM, was related to obesity, age .68 years,
lower physical activity and low education level, and the non-Spanish born seem to have a
lower prevalence of DM.12 More studies should be performed to analyse the reasons for
these differences.
Sex was not associated with DM, while age 740 years was. Although we could not determine
the type of DM in subjects analysed in this study due to the manner in which data for this
variable were collected, it is known that the prevalence of type 2 DM increases with age.12
Adults with DM were more likely to require hospitalisation and present with adverse effects
than non-diabetics. Infections can contribute to glycaemic imbalance and may occasionally
require the admin- istration of insulin during the initial phases. It should also be noted that
some anti-tuberculosis drugs may favour the appearance of disorders associated with DM, as
is the case with INH, or may alter the metabolism of other chronic treatment drugs and
increase glucose levels, as is the case with RMP.5
Although DM has been related to M. tuberculosis resistance5 and to delayed sputum
conversion,20 this study did not find DM to be associated with INH or RMP resistance or
MDR-TB, nor to the degree of positivity of sputum cultures at the initiation of antituberculosis treatment. The reason may be the low prevalence of resistance in our setting,
particularly among native Spaniards. In 2012, the rate of INH resistance was 6.4% among
native Spaniards and 8.6% among immigrants; the corresponding figures for RMP were
respectively 0.9% and 1.7%.17
Contrary to reports from India,6 we found no clear association between extra-pulmonary or
purely pul- monary forms of TB (in comparison to mixed forms) among adults with DM.
However, we did find an association between presence of cavitation on CXR, as reported by
some authors,5,22 and the number of cases for which no CXR information was available.

1510 The International Journal of Tuberculosis and Lung Disease

Table Factors associated with diabetes mellitus in 5849 adult patients with tuberculosis.
Barcelona, 20002013

Diabetes mellitus Bivariate analysis

Total
(n
5849)

No

Yes

Multivariate
analysis

n
Clinical form of TB
Pulmonary, smearpositive
Pulmonary, smearnegative,
culture-positive
Extra-pulmonary
Pulmonary, culturenegative
Sex
Female
Male
Age group, years
1839
740
Country of birth
Foreign
Spain

n (%)

n (%)

OR
(95%CI)

P value

OR
(95%CI)

P value

2146 2012(93.8)134(6.2) Reference Reference

0.88 (0.66
0.379
1.17)
0.99 (0.76
1597 1498(93.8 99 (6.2)
0.957
1.30)
0.87 (0.58
606 573 (94.6)33 (5.4)
0.474
1.27)
1498 1415(94.5)83 (5.5)

2105 1993(94.7)112(5.3) Reference Reference

1.20 (0.96
3744 3507(93.7)237(6.3)
0.117
1.52)
2897 2853(98.5)44 (1.5) Reference Reference
7.45 (5.46
6.08 (4.36
2952 2647(89.7)305(10.3)
,0.001
,0.001*
10.4)
8.66)*
2461 2387(97) 74 (3)

Reference Reference
2.84 (2.20
1.46 (1.11
3388 3113(91.9)275(8.1)
,0.001
0.008*
3.72)
1.96)*

New case
Yes

5343 5024(94) 319(6)

No

506

Reference Reference
1.00 (0.66
476 (94.1)30 (5.9)
0.989
1.44)

Chest X-ray
1.27 (0.97
1.42 (1.08
0.079
,0.001*
1.64)
1.86)*
Abnormal, no cavitation3409 3221(94.5)188(5.5) Reference Reference
1.76 (0.81
2.36 (1.06
Unknown
98
89 (90.8)9 (9.2)
0.143
0.021*
3.37)
4.71)*
1.10 (0.81
1.16 (0.85
Normal
1033 971 (94) 62 (6)
0.548
0.317*
1.46)
1.58)*
Homelessness
Yes
428 405 (94.6)23 (5.4) Reference Reference
1.12 (0.74
No
5421 5095(94) 326(6)
0.606
1.78)
Alcoholism
Yes
1212 1129(93.2)83 (6.8) Reference Reference
0.83 (0.64
No
4637 4371(94.3)266(5.7)
0.150
1.07)
Smoker
Yes
2418 2268(93.8)150(6.2) Reference Reference
0.93 (0.75
No
3431 3232(94.2 199(5.8
0.521
1.16)
Cavitation

1309 1219(93.1)90 (6.9)

History of incarceration
Yes
161
No

156 (96.9)5

(3.1) Reference Reference

1.95 (0.88
5672 5329(94) 343(6)
0.106
5.58)

IDU/HIV status
IDU, HIV

5143 4808(93.5)335(6.5) Reference Reference

IDU, HIV

300

299 (99.7)1

(0.3)

IDU, HIV

336

330 (98.2)6

(1.8)

IDU, HIV

70

63

Hospitalisation
No
Yes
Unknown
Prior
immunosuppressive
treatment
No
Yes
Adverse effects of
treatment
No
Yes
Died
No
Yes

(90) 7

0.05 (0.00
,0.001
0.24)

0.27 (0.10
,0.001
0.55)
1.63 (0.67
(10)
0.259
3.35)

0.04
(0.002
0.001*
0.19)*
0.27 (0.10
0.002*
0.57)*
1.85 (0.74
0.144*
3.99)*

2398 2300(95.9)98 (4.1) Reference Reference

1.86 (1.47
1.80 (1.40
3355 3108(92.6)247(7.4)
,0.001
,0.001*
2.38)
2.31)*
1.06 (0.31
1.11 (0.31
96
92 (95.8)4 (4.2)
0.915
0.833*
2.60)
2.82)*

5627 5303(94.2)324(5.8) Reference Reference

2.09 (1.33
222 197 (88.7)25 (11.3)
0.002
3.15)
5460 5152(94.4)308(5.6) Reference Reference
1.98 (1.38
1.86 (1.28
389 348 (89.5)41 (10.5)
,0.001
,0.001*
2.76)
2.64)*
5381 5083(94.5)298(5.5) Reference Reference
2.09 (1.51
468 417 (89.1)51 (10.9)
,0.001
2.84)

* Statistically significant.
OR odds ratio; CI confidence interval; TB tuberculosis; IDU injection drug use;
negative; HIV human immunodeficiency virus; positive.
Some studies have suggested that DM increases not only the risk of acquiring TB but also the
severity of the disease, the number of relapses and the risk of death due to TB.5,2325
However, this study did not find the rate of any-cause mortality during anti- tuberculosis
treatment to be significantly associated
with DM. The lack of clinical and analytical data did not permit us to establish a relationship
between these events and poor DM control, as suggested in some studies.5,26
In this study, HIV infection was associated with a lower probability of DM, in contrast to the
results of

DM among adults with TB 1511

another published study.27 In our study, this applied to both patients with a history of IDU
and those without. While some studies have shown that HIV infection could be a risk
factor,28 this could be related to the use of certain antiretroviral drugs, particularly some
protease inhibitors.2931 No data were available on the antiretroviral drugs used. More
studies are needed to clarify the relationship between HIV infection, antiretroviral therapy,
IDU, DM and TB.
In the light of the differences between the various studies, it is important to understand the
relationship between TB and DM in different regions around the world to establish priorities
and adapt the needs of prevention and control programmes. In high DM prevalence, high TB
burden countries with weak public health programmes, the current recommenda- tion is to
rule out TB and latent tuberculous infection among diabetics, and rule out DM among TB
patients. This recommendation could be extended to immigrants from areas with a high
prevalence of both diseases.
We found no population-based studies from industrialised countries analysing the relationship
between DM and TB; this study therefore provides relevant information about this dual
problem. Our study included all cases detected through a city TB control programme with
very high coverage and notification rates, and active epidemiological surveil- lance, including
monitoring of microbiological test results, hospital discharges and record linkage be- tween
mortality, HIV-TB and other registries. The analysis was restricted to adults to avoid bias.
Limitations
The lack of clinical, analytical and body mass index data precluded any analysis of the
relationship between insufficient DM control and the evolution of TB. The majority of
diabetic cases were classified as such and included in the analysis on the basis of information
provided either by the patient or by the patients family, or obtained from patient clinical
records systematically reviewed by public health personnel and reported by epidemiological
surveys. Although DM may have been underestimated, these methods should be valid for
chronic diseases.32 As the questionnaires used by the Barcelona TB Programme do not
differentiate by type of DM, it was not possible to analyse the two diseases separately. Time
to sputum conversion could not be analysed as neither data on sputum culture during
treatment nor results from samples obtained at the end of the intensive phase were available.
CONCLUSIONS
DM prevalence among adults with TB in Barcelona was low and remained stable over the 14year study period. In Barcelona, DM is associated with age 740
years, being Spanish-born, hospitalisation, cavitation on CXR and adverse effects due to antituberculosis treatment. HIV infection was associated with a lower probability of DM.
The DM prevalence and profile in a large industrialised city may differ from those in
develop- ing countries, but TB in DM patients is always more complicated. All of this ought

to be taken into consideration when developing TB control pro- grammes to achieve better
coordination among programmes targeting DM, smoking, HIV, etc.
Acknowledgements
Other members of TB-Diabetes Working Group of the Barcelona TB Investigation Unit
(Unidad de Investigacion en Tuberculosis de Barcelona, UITB): M L De Souza-Galvao, M
A Jimenez-Fuentes (Unitat de Tuberculosi, Vall dHebron-Drassanes Hospital Uni- versitari,
Vall dHebron, Barcelona); I Molina, A Curran (Infectious Diseases Department, Hospital
Universitari de la Vall dHebron, Barcelona); M A Sambeat, V Pomar (Infectious Diseases
Unit, Hospital de la Santa Creu i Sant Pau, Barcelona); H Knobel, F Sanchez-Martnez
(Hospital del Mar, Instituto Hospital del Mar de Investigaciones Medicas, Barcelona); J A
Martnez, J M Miro (Infectious Diseases Service, Hospital Clnic de Barcelona, Barcelona, Spain).
Conflicts of interest: none declared.
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DM among adults with TB i

C A D R E : Le diabete` (DM) peut contribuerau
developpement de la tuberculose (TB).
O B J E C T I F : Analyser la prevalencedu DM et ses
facteurs associes parmi les adultes atteints de TB dans une grande ville dun pays developp
.
Etude en population chez
PAT I E N T S E T M E T H O D E :
des adultes ayant eu un diagnostic de TB entre 2000 et 2013 a` Barcelone. Nous avons etudi
les facteurs sociodemographiques et cliniques/epidemiologiques potentiellement associes.

La regression logistique a et utilisee pour calculer les odds ratios (OR) et leurs intervalles
de confiance (IC) a` 95%.
Sur un total de 5849 patients TB, 349
R E S U LTAT S :
(5,9%) avaient un DM. La prevalence annuelle du DM allait de 4,0% a` 7,2%. Les facteurs
associes au DM ont et naissance en Espagne (OR 1,46 ; IC95% 1,111,96) ;
RESUME
age de 740 ans (OR 6,08 ; IC95% 4,368,66) ; profil cavitaire de la radiographie pulmonaire
(OR 1,42 ; IC95% 1,081,86) ; survenue de plus deffets secondaires au traitement antituberculeux (OR 1,86 ; IC95% 1,282,64) ; et hospitalisation au moment du diagnostic (OR
1,8 ; IC95% 1,402,31). Linfection a` virus de limmunodeficience humaine a et associee
avec une probabilite plus faible de DM, chez les sujets ayant des antecedents dutilisation
de drogues injectables (OR 0,27 ; IC95% 0,100,57) et ceux sans ces antecedents (OR
0,04 ; IC95% 0,0020,19).
C O N C L U S I O N : La prevalence du DM parmi les adultes atteints de TB a` Barcelone
est faible et est restee stable tout au long des 14 annees. Cependant, les patients TB avec
DM ont et potentiellement plus contagieux et plus compliques en termes de prise en charge
clinique.
M A R C O D E R E F E R E N C I A: La diabetes mellitus (DM) puede contribuir al
desarrollo de tuberculosis (TB).
O B J E T I V O: Analizar la prevalencia de DM entre los adultos con TB y los factores
asociados en una gran ciudad de un pas industrializado.
Estudio poblacional realizado en adultos
M E T O D O S:
diagnosticados de TB entre 2000 y 2013 en Barcelona. Se estudiaron factores sociodemogra
ficos, clnicos y epidemiologicos potencialmente asociados. Se utilizo regresion logstica
para calcular odds ratios (OR) con intervalos de confianza (IC) del 95%.
R E S U LTA D O S: De un total de 5849 pacientes con TB, 349 (5,9%) tenan DM. La
prevalencia anual de DM fue del 4,0% al 7,2%. Los factores asociados con DM fueron ser
espanol (OR 1,46; IC95% 1,111,96); tener 740 anos (OR 6,08; IC95% 4,368,66);
cavitacion en
RESUMEN
la radiografa de torax (OR 1,42; IC95% 1,081,86); presentar ma s efectos secundarios del
tratamiento antituberculoso (OR 1,86; IC95% 1,282,64); y hospitalizacion en el momento
del diagnostico (OR 1,8; IC95% 1,402,31). La infeccion por virus de la inmunodeficiencia
humana se asocio con una baja probabilidad de tener DM, tanto con antecedentes de abuso

de drogas inyectadas (OR 0,27; IC95% 0,10 0,57) como en su ausencia (OR 0,04; IC95%
0,002 0,19).
C O N C L U S I O N E S: La prevalencia de DM entre los adultos con TB en Barcelona es
baja y ha permanecido estable entre 2000 y 2013. Sin embargo, los pacientes con TB y DM
son potencialmente mas contagiosos y su manejo clnico mas complicado.

B A C K G R O U N D: Diabetes mellitus (DM) dapat berkontribusi pada pengembangan

tuberkulosis (TB).
O B J E C T I V E: untuk menganalisis prevalensi DM dan faktor-faktor yang terkait antara
orang dewasa dengan TB di sebuah kota besar di negara industri maju.
M E T H O D S: Ini adalah studi berdasarkan populasi orang dewasa didiagnosis dengan TB
antara 2000 dan 2013 di Barce-lona. Kita mempelajari faktor sociodemo-grafis dan
klinis/epidemiologi yang berpotensi terkait. Regresi logistik digunakan untuk menghitung
peluang rasio (ORs) dan mereka 95% confidence interval (CIs).
R E S U LT S: 5849 TB pasien, 349 (5,9%) punya DM. Prevalensi tahunan DM berkisar dari
4,0% 7,2%. Faktor-faktor yang terkait dengan DM sedang Spanyol Lahir (atau 1.46, 95% CI
1,11-1,96), usia 740 tahun (atau 6,08, 95% CI 4.36 8.66), cavitary pola pada dada XS U M M AR Y
Ray (atau 1,42, 95% CI 1,08-1,86), mengalami efek samping lain pengobatan antituberkulosis (atau 1,86, 95% CI 1,28-2.64) dan rumah sakit pada saat diagnosis (atau 1,8,
95% CI 1,40-2.31). Infeksi virus immu-nodeficiency manusia dipertalikan dengan
probabilitas rendah DM di kedua mata pelajaran dengan sejarah penggunaan narkoba
suntikan (atau 0.27, 95% CI 0,10-0,57) dan mereka yang tidak (atau 0,04, 95% CI 0,0020.19).
C O N C L U S I O N S: DM prevalensi di antara orang dewasa dengan TB di Barcelona
rendah dan tetap stabil selama periode studi 14 tahun. Namun, TB penderita DM berpotensi
lebih infeksius dan mereka klinis manajemen adalah lebih rumit.
K E Y W O R D S: umur; Infeksi HIV; pengguna narkoba suntikan; efek samping; pola
cavitary
Federasi DIABETES Internasional memperkirakan bahwa oleh 2011, lebih dari 366 juta
orang usia 20-79 tahun, mewakili 8.3% dari populasi dunia, akan memiliki diabetes mellitus
(DM). Diharapkan bahwa 2030, DM akan menjadi penyebab terbesar ketujuh kematian
seluruh dunia.1