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Diabetes Mellitus Increases the Risk of Active Tuberculosis: A Systematic Review of 13 Observational Studies

17 Jul 2008

Paul Chinnock

Source: PLoS Medicine (see original article)

Citation: Jeon CY, Murray MB (2008) Diabetes Mellitus Increases the Risk of Active Tuberculosis: A Systematic Review of 13 Observational Studies. PLoS Med; 5(7): e152

2008 Jeon and Murray. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

For many years it has been argued that people with diabetes are more likely than other people to suffer from tuberculosis (TB). This is a serious issue for TB control, as diabetes – once thought of as a public health issue only in high-income nations – is becoming more common in poorer countries and communities where the risk of TB infection is already high.

Till now, however, the evidence to back up such an assertion has not been strong; many of the studies suggesting an association between TB and diabetes were not well conducted and from their data it is impossible to conclude whether diabetes increased the likelihood of TB infection or whether, conversely, TB promoted the development of the symptoms of diabetes.

In a systematic review, Jeon and Murray looked for observational studies that had examined whether diabetes mellitus increases the risk of active tuberculosis. As their aim was to summarize the effect of DM on TB, they did not include studies that investigated the reverse association.

Diabetes was positively associated with TB in all but one of their 13 included studies, but the estimates of how much diabetes increases the risk of developing active TB were highly variable, ranging from no effect to an increased risk of nearly eight-fold in one study. Despite the variation, the review provides strong support for the view that diabetes increases the risk of developing TB.

The reviewers also point out that there have been animal and in vitro studies indicating that diabetes impairs the ability of the immune system to fight Mycobacterium tuberculosis, the organism which causes TB. The findings of the review are therefore biologically plausible.

The authors conclude that people with diabetes may be important targets for interventions, such as active case finding and treatment of latent TB; and efforts to diagnose, detect, and treat diabetes may have a beneficial impact on TB control.

Every year, 8.8 million people develop active TB and 1.6 million people die from the infection. 180 million people currently have diabetes, but this number is expected to double by 2030. Low- to middle-income countries have the highest burden of TB and are experiencing the fastest increase in diabetes prevalence.

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