The effect of diabetes mellitus on tuberculosis in eastern China: A decision-tree analysis based on a real-world study
中国东部地区糖尿病对肺结核的影响:基于真实世界研究的决策树分析
Yuxiao Ling
School of Public Health, Health Science Center, Ningbo University, Ningbo, China
Search for more papers by this authorXinyi Chen
Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
Search for more papers by this authorMeng Zhou
Zhejiang University School of Public Health, Hangzhou, China
Search for more papers by this authorMengdie Zhang
Zhejiang University School of Public Health, Hangzhou, China
Search for more papers by this authorDan Luo
Department of Public Health, Hangzhou Medical College, Hangzhou, China
Search for more papers by this authorCorresponding Author
Wei Wang
Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
Correspondence
Wei Wang and Bin Chen, Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China. Email: [email protected] and [email protected]
Jianmin Jiang, Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Bin Chen
Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
Correspondence
Wei Wang and Bin Chen, Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China. Email: [email protected] and [email protected]
Jianmin Jiang, Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Jianmin Jiang
Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
Correspondence
Wei Wang and Bin Chen, Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China. Email: [email protected] and [email protected]
Jianmin Jiang, Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China.
Email: [email protected]
Search for more papers by this authorYuxiao Ling
School of Public Health, Health Science Center, Ningbo University, Ningbo, China
Search for more papers by this authorXinyi Chen
Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
Search for more papers by this authorMeng Zhou
Zhejiang University School of Public Health, Hangzhou, China
Search for more papers by this authorMengdie Zhang
Zhejiang University School of Public Health, Hangzhou, China
Search for more papers by this authorDan Luo
Department of Public Health, Hangzhou Medical College, Hangzhou, China
Search for more papers by this authorCorresponding Author
Wei Wang
Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
Correspondence
Wei Wang and Bin Chen, Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China. Email: [email protected] and [email protected]
Jianmin Jiang, Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Bin Chen
Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
Correspondence
Wei Wang and Bin Chen, Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China. Email: [email protected] and [email protected]
Jianmin Jiang, Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China.
Email: [email protected]
Search for more papers by this authorCorresponding Author
Jianmin Jiang
Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China
Correspondence
Wei Wang and Bin Chen, Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China. Email: [email protected] and [email protected]
Jianmin Jiang, Key Laboratory of Vaccine, Prevention and Control of Infectious Disease of Zhejiang Province, Hangzhou, China.
Email: [email protected]
Search for more papers by this authorYuxiao Ling and Xinyi Chen contributed equally to this study and share the first authorship.
Abstract
enObjectives
The public health system faces major challenges due to the double burden of diabetes mellitus (DM) and tuberculosis (TB) in China. We aimed to investigate the prevalence and impact of diabetes on patients with TB.
Methods
Stratified cluster sampling was used to select 13 counties as study sites in the Zhejiang province. Patients who visited designated TB hospitals in these areas participated in this study between 1 January 2017 and 28 February 2019. Multiple logistic regression models were performed to investigate the association between DM and bacteriological and imaging results. A decision tree was used to predict the bacteriology and imaging results under the influence of DM.
Results
Of 5920 patients with newly diagnosed pulmonary tuberculosis, 643 (12.16%) had DM. Patients with pulmonary TB and DM were more likely to have pulmonary cavities (adjusted odds ratio [aOR], 2.81; 95% confidence intervals [95% CI]: 2.35–3.37) and higher rates of positive bacteriological tests (aOR, 2.32; 95% CI:1.87–2.87). Decision-tree analysis showed similar results.
Conclusions
Concurrence of DM and pulmonary TB makes patients more likely to have positive bacteriological results and pulmonary cavities. Therefore, appropriate measures are necessary to promptly identify and manage patients with TB and DM.
摘要
zh目的:由于糖尿病(DM)和肺结核(TB)在中国的双重负担, 公共卫生系统面临着重大挑战。我们旨在调查糖尿病患者中肺结核的患病率和影响。
方法:在浙江省选择了13个县作为研究地点, 采用分层集群抽样的方法。在这些地区指定的肺结核医院就诊的患者参与了这项研究, 研究时间为2017年1月1日至2019年2月28日。进行多项逻辑回归模型研究DM与细菌学和影像学结果之间的关联性。使用决策树预测在DM影响下的细菌学和影像学结果。
结果:在5920例新诊断的肺结核患者中, 有643例(12.16%)患有DM。同时患有肺结核和DM的患者更可能出现肺空洞(调整后的比值比[aOR]为2.81；95%置信区间[95% CI]为2.35-3.37), 并且细菌学检测阳性率更高(aOR为2.32；95% CI为1.87-2.87)。决策树分析显示出类似结果。
结论:同时患有肺结核和DM的患者更容易出现细菌学检测结果阳性和肺空洞。有必要采取适当措施及时识别和管理同时患有TB和DM的患者。
CONFLICT OF INTEREST STATEMENT
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Supporting Information
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REFERENCES
- 1 World Health Organization. Global tuberculosis report 2022. World Health Organization; 2023 Accessed 6 March, 2023. https://www.who.int/teams/global-tuberculosis-programme/tb-reports/global-tuberculosis-report-2022
- 2Wang L, Peng W, Zhao Z, et al. Prevalence and treatment of diabetes in China, 2013-2018. JAMA. 2021; 326(24): 2498-2506. doi:10.1001/jama.2021.22208
- 3Sun H, Saeedi P, Karuranga S, et al. IDF diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022; 183:109119. doi:10.1016/j.diabres.2021.109119
- 4Wu Q, Liu Y, Ma YB, Liu K, Chen SH. Incidence and prevalence of pulmonary tuberculosis among patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Ann Med. 2022; 54(1): 1657-1666. doi:10.1080/07853890.2022.2085318
- 5Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med. 2008; 5(7):e152. doi:10.1371/journal.pmed.0050152
- 6Noubiap JJ, Nansseu JR, Nyaga UF, et al. Global prevalence of diabetes in active tuberculosis: a systematic review and meta-analysis of data from 2.3 million patients with tuberculosis. Lancet Glob Health. 2019; 7(4): e448-e460. doi:10.1016/S2214-109X(18)30487-X
- 7Ayelign B, Negash M, Genetu M, Wondmagegn T, Shibabaw T. Immunological impacts of diabetes on the susceptibility of mycobacterium tuberculosis. J Immunol Res. 2019; 2019:6196532. doi:10.1155/2019/6196532
- 8Wu Q, Wang M, Zhang Y, et al. Epidemiological characteristics and their influencing factors among pulmonary tuberculosis patients with and without diabetes mellitus: a survey study from drug resistance surveillance in East China. Front Public Health. 2021; 9:777000. doi:10.3389/fpubh.2021.777000
- 9Cheng J, Zhang H, Zhao YL, Wang LX, Chen MT. Mutual impact of diabetes mellitus and tuberculosis in China. Biomed Environ Sci. 2017; 30(5): 384-389. doi:10.3967/bes2017.051
- 10Jiménez-Corona ME, Cruz-Hervert LP, García-García L, et al. Association of diabetes and tuberculosis: impact on treatment and post-treatment outcomes. Thorax. 2013; 68(3): 214-220. doi:10.1136/thoraxjnl-2012-201756
- 11Armstrong LR, Kammerer JS, Haddad MB. Diabetes mellitus among adults with tuberculosis in the USA, 2010-2017. BMJ Open Diabetes Res Care. 2020; 8(1):e001275. doi:10.1136/bmjdrc-2020-001275
- 12Vaishya R, Misra A, Vaish A, Singh SK. Diabetes and tuberculosis syndemic in India: a narrative review of facts, gaps in care and challenges. J Diabetes. 2023;1-10. doi:10.1111/1753-0407.13427
- 13Rupani MP, Vyas S. A sequential explanatory mixed-methods study on costs incurred by patients with tuberculosis comorbid with diabetes in Bhavnagar, western India. Sci Rep. 2023; 13(1): 150. doi:10.1038/s41598-023-27494-7
- 14Alkabab YM, Al-Abdely HM, Heysell SK. Diabetes-related tuberculosis in the Middle East: an urgent need for regional research. Int J Infect Dis. 2015; 40: 64-70. doi:10.1016/j.ijid.2015.09.010
- 15Zheng C, Hu M, Gao F. Diabetes and pulmonary tuberculosis: a global overview with special focus on the situation in Asian countries with high TB-DM burden. Glob Health Action. 2017; 10(1): 1-11. doi:10.1080/16549716.2016.1264702
- 16Liu K, Li T, Vongpradith A, et al. Identification and prediction of tuberculosis in eastern China: analyses from 10-year population-based notification data in Zhejiang Province, China. Sci Rep. 2020; 10(1): 7425. doi:10.1038/s41598-020-64387-5
- 17Wang M, Gong WW, Pan J, et al. Incidence and time trends of type 2 diabetes mellitus among adults in Zhejiang Province, China, 2007-2017. J Diabetes Res. 2020; 2020:2597953. doi:10.1155/2020/2597953
- 18Du Q, Wang L, Long Q, Zhao Y, Abdullah AS. Systematic review and meta-analysis: prevalence of diabetes among patients with tuberculosis in China. Trop Med Int Health. 2021; 26(12): 1553-1559. doi:10.1111/tmi.13686
- 19Xiao W, Huang D, Li S, et al. Delayed diagnosis of tuberculosis in patients with diabetes mellitus co-morbidity and its associated factors in Zhejiang Province, China. BMC Infect Dis. 2021; 21(1): 272. doi:10.1186/s12879-021-05929-8
- 20Mave V, Gaikwad S, Barthwal M, et al. Diabetes mellitus and tuberculosis treatment outcomes in Pune, India. Open Forum Infect Dis. 2021; 8(4):ofab097. doi:10.1093/ofid/ofab097
- 21Dousa KM, Hamad A, Albirair M, et al. Impact of diabetes mellitus on the presentation and response to treatment of adults with pulmonary tuberculosis in Qatar. Open Forum Infect Dis. 2019; 6(1):ofy335. doi:10.1093/ofid/ofy335
- 22Abd el-Hamid el-Kady R, Abdulrahman Turkistani S. The footprint of diabetes mellitus on the characteristics and response to anti-tuberculous therapy in patients with pulmonary tuberculosis from Saudi Arabia. Infect Drug Resist. 2021; 14: 5303-5312. doi:10.2147/IDR.S344703
- 23Zhu W, Wang Y, Li T, Chen W, Wang W. Gap to end-TB targets in eastern China: a joinpoint analysis from population-based notification data in Zhejiang Province, China, 2005-2018. Int J Infect Dis. 2021; 104: 407-414. doi:10.1016/j.ijid.2021.01.007
- 24Liu K, Xie Z, Xie B, et al. Bridging the gap in end tuberculosis targets in the elderly population in eastern China: observational study from 2015 to 2020. JMIR Public Health Surveill. 2022; 8(7):e39142. doi:10.2196/39142
- 25Tramunt B, Smati S, Grandgeorge N, et al. Sex differences in metabolic regulation and diabetes susceptibility. Diabetologia. 2020; 63(3): 453-461. doi:10.1007/s00125-019-05040-3
- 26Kumar Nathella P, Babu S. Influence of diabetes mellitus on immunity to human tuberculosis. Immunology. 2017; 152(1): 13-24. doi:10.1111/imm.12762
- 27Martinez N, Kornfeld H. Diabetes and immunity to tuberculosis. Eur J Immunol. 2014; 44(3): 617-626. doi:10.1002/eji.201344301
- 28Ferlita S, Yegiazaryan A, Noori N, et al. Type 2 diabetes mellitus and altered immune system leading to susceptibility to pathogens, especially mycobacterium tuberculosis. J Clin Med. 2019; 8(12): 2219. doi:10.3390/jcm8122219
- 29Wu Z, Guo J, Huang Y, et al. Diabetes mellitus in patients with pulmonary tuberculosis in an aging population in Shanghai, China: prevalence, clinical characteristics and outcomes. J Diabetes Complications. 2016; 30(2): 237-241. doi:10.1016/j.jdiacomp.2015.11.014
- 30Guirado E, Schlesinger LS, Kaplan G. Macrophages in tuberculosis: friend or foe. Semin Immunopathol. 2013; 35(5): 563-583. doi:10.1007/s00281-013-0388-2
- 31Podell BK, Ackart DF, Obregon-Henao A, et al. Increased severity of tuberculosis in Guinea pigs with type 2 diabetes: a model of diabetes-tuberculosis comorbidity. Am J Pathol. 2014; 184(4): 1104-1118. doi:10.1016/j.ajpath.2013.12.015
- 32Russell DG. Who puts the tubercle in tuberculosis? Nat Rev Microbiol. 2007; 5(1): 39-47. doi:10.1038/nrmicro1538
- 33Yew WW, Leung CC, Zhang Y. Oxidative stress and TB outcomes in patients with diabetes mellitus? J Antimicrob Chemother. 2017; 72(6): 1552-1555. doi:10.1093/jac/dkx046
- 34Sanghani RN, Udwadia ZF. The association of diabetes and tuberculosis: impact on treatment and post-treatment outcomes. Thorax. 2013; 68(3): 202-203. doi:10.1136/thoraxjnl-2012-202976
- 35Lee EH, Lee JM, Kang YA, et al. Prevalence and impact of diabetes mellitus among patients with active pulmonary tuberculosis in South Korea. Lung. 2017; 195(2): 209-215. doi:10.1007/s00408-017-9978-4
- 36Alisjahbana B, Sahiratmadja E, Nelwan EJ, et al. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin Infect Dis. 2007; 45(4): 428-435. doi:10.1086/519841
- 37Makuka GJ, Balandya E, Munseri P. Burden of active pulmonary tuberculosis among patients with diabetes in Dar es Salaam, Tanzania: a cross-sectional study. BMJ Open. 2022; 12(11):e065969. doi:10.1136/bmjopen-2022-065969
- 38Stevenson CR, Forouhi NG, Roglic G, et al. Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence. BMC Public Health. 2007; 7: 234. doi:10.1186/1471-2458-7-234
- 39Kossii Iu E, Karachunskii MA, Kaminskaia GO, Chernykh NA, Zhukovskaia DE. Pulmonary tuberculosis in patients with different types of diabetes mellitus. Probl Tuberk. 2002;(5): 21-24.
- 40Shen TC, Lin CL, Wei CC, et al. Increased risk of tuberculosis in patients with type 1 diabetes mellitus: results from a population-based cohort study in Taiwan. Medicine (Baltimore). 2014; 93(16):e96. doi:10.1097/MD.0000000000000096
