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Glycemic control and the risk of tuberculosis in patients with diabetes: A cohort study in a Mediterranean city
BACKGROUND: Diabetes mellitus (DM) is one of the leading chronic diseases globally and one of the most common causes of death, morbidity, and poor quality of life. According to the WHO, DM is also one of the main risk factors for developing active tuberculosis (TB). Subjects with DM are at a higher...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9713231/ https://www.ncbi.nlm.nih.gov/pubmed/36466495 http://dx.doi.org/10.3389/fpubh.2022.1017024 |
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author | Antonio-Arques, Violeta Caylà, Joan A. Real, Jordi Moreno-Martinez, Antonio Orcau, Àngels Mauricio, Didac Mata-Cases, Manel Julve, Josep Navas Mendez, Elena Puig Treserra, Rai Millet, Joan Pau Del Val García, Jose Luis Vlacho, Bogdan Franch-Nadal, Josep |
author_facet | Antonio-Arques, Violeta Caylà, Joan A. Real, Jordi Moreno-Martinez, Antonio Orcau, Àngels Mauricio, Didac Mata-Cases, Manel Julve, Josep Navas Mendez, Elena Puig Treserra, Rai Millet, Joan Pau Del Val García, Jose Luis Vlacho, Bogdan Franch-Nadal, Josep |
author_sort | Antonio-Arques, Violeta |
collection | PubMed |
description | BACKGROUND: Diabetes mellitus (DM) is one of the leading chronic diseases globally and one of the most common causes of death, morbidity, and poor quality of life. According to the WHO, DM is also one of the main risk factors for developing active tuberculosis (TB). Subjects with DM are at a higher risk of infections, in addition to frequent micro and macrovascular complications, and therefore sought to determine whether poor glycemic control is linked to a higher risk of developing TB. METHODS: We used a retrospective cohort of diabetic subjects to predict the incidence of TB. All DM patients were recruited from Ciutat Vella (the inner-city of Barcelona) from January 2007 until December 2016, with a follow-up period until December 2018 (≥2 years). Data were extracted from Barcelona's Primary Care medical record database - SIDIAP, and linked to the Barcelona TB Control Program. The incidence of TB and the impact of glycemic control were estimated using time-to-event curves analyzed by Cox proportional hazard regression. Hazard ratios (HRs) and 95% confidence intervals (CIs), unadjusted and adjusted by potential confounding variables, were also assessed, which included age, sex, diabetes duration, macrovascular and microvascular signs, BMI, smoking habit, alcohol consumption and geographical origin. RESULTS: Of 8,004 DM patients considered for the study (equating to 68,605 person-years of follow-up), 84 developed TB [incidence rate = 70 (95% CI: 52–93) per 100,000 person-years]. DM subjects with TB were younger (mean: 52.2 vs. 57.7 years old), had higher values of glycosylated hemoglobin (HbA1c) (7.66 vs. 7.41%) and total triglycerides (122 vs. 105 mg/dl), and had twice the frequency of diabetic nephropathy (2.08 vs. 1.18%). The calculated incidence rate increased with increasing HbA1c: 120.5 (95% CI 77.2–179.3) for HbA1c ≥ 7.5%, 143 (95% CI 88.3–218.1) for HbA1c ≥ 8% and 183.8 (95% CI 105–298) for HbA1c ≥ 9%. An increase in the risk of TB was also observed according to a poorer optimization of glycemic control: adjusted HR 1.80 (95% CI 0.60–5.42), 2.06 (95% CI 0.67–6.32), and 2.82 (95% CI 0.88–9.06), respectively. CONCLUSION: Diabetic subjects with worse glycemic control show a trend toward a higher risk of developing TB. |
format | Online Article Text |
id | pubmed-9713231 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-97132312022-12-02 Glycemic control and the risk of tuberculosis in patients with diabetes: A cohort study in a Mediterranean city Antonio-Arques, Violeta Caylà, Joan A. Real, Jordi Moreno-Martinez, Antonio Orcau, Àngels Mauricio, Didac Mata-Cases, Manel Julve, Josep Navas Mendez, Elena Puig Treserra, Rai Millet, Joan Pau Del Val García, Jose Luis Vlacho, Bogdan Franch-Nadal, Josep Front Public Health Public Health BACKGROUND: Diabetes mellitus (DM) is one of the leading chronic diseases globally and one of the most common causes of death, morbidity, and poor quality of life. According to the WHO, DM is also one of the main risk factors for developing active tuberculosis (TB). Subjects with DM are at a higher risk of infections, in addition to frequent micro and macrovascular complications, and therefore sought to determine whether poor glycemic control is linked to a higher risk of developing TB. METHODS: We used a retrospective cohort of diabetic subjects to predict the incidence of TB. All DM patients were recruited from Ciutat Vella (the inner-city of Barcelona) from January 2007 until December 2016, with a follow-up period until December 2018 (≥2 years). Data were extracted from Barcelona's Primary Care medical record database - SIDIAP, and linked to the Barcelona TB Control Program. The incidence of TB and the impact of glycemic control were estimated using time-to-event curves analyzed by Cox proportional hazard regression. Hazard ratios (HRs) and 95% confidence intervals (CIs), unadjusted and adjusted by potential confounding variables, were also assessed, which included age, sex, diabetes duration, macrovascular and microvascular signs, BMI, smoking habit, alcohol consumption and geographical origin. RESULTS: Of 8,004 DM patients considered for the study (equating to 68,605 person-years of follow-up), 84 developed TB [incidence rate = 70 (95% CI: 52–93) per 100,000 person-years]. DM subjects with TB were younger (mean: 52.2 vs. 57.7 years old), had higher values of glycosylated hemoglobin (HbA1c) (7.66 vs. 7.41%) and total triglycerides (122 vs. 105 mg/dl), and had twice the frequency of diabetic nephropathy (2.08 vs. 1.18%). The calculated incidence rate increased with increasing HbA1c: 120.5 (95% CI 77.2–179.3) for HbA1c ≥ 7.5%, 143 (95% CI 88.3–218.1) for HbA1c ≥ 8% and 183.8 (95% CI 105–298) for HbA1c ≥ 9%. An increase in the risk of TB was also observed according to a poorer optimization of glycemic control: adjusted HR 1.80 (95% CI 0.60–5.42), 2.06 (95% CI 0.67–6.32), and 2.82 (95% CI 0.88–9.06), respectively. CONCLUSION: Diabetic subjects with worse glycemic control show a trend toward a higher risk of developing TB. Frontiers Media S.A. 2022-11-17 /pmc/articles/PMC9713231/ /pubmed/36466495 http://dx.doi.org/10.3389/fpubh.2022.1017024 Text en Copyright © 2022 Antonio-Arques, Caylà, Real, Moreno-Martinez, Orcau, Mauricio, Mata-Cases, Julve, Navas Mendez, Puig Treserra, Millet, Del Val García, Vlacho and Franch-Nadal. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Public Health Antonio-Arques, Violeta Caylà, Joan A. Real, Jordi Moreno-Martinez, Antonio Orcau, Àngels Mauricio, Didac Mata-Cases, Manel Julve, Josep Navas Mendez, Elena Puig Treserra, Rai Millet, Joan Pau Del Val García, Jose Luis Vlacho, Bogdan Franch-Nadal, Josep Glycemic control and the risk of tuberculosis in patients with diabetes: A cohort study in a Mediterranean city |
title | Glycemic control and the risk of tuberculosis in patients with diabetes: A cohort study in a Mediterranean city |
title_full | Glycemic control and the risk of tuberculosis in patients with diabetes: A cohort study in a Mediterranean city |
title_fullStr | Glycemic control and the risk of tuberculosis in patients with diabetes: A cohort study in a Mediterranean city |
title_full_unstemmed | Glycemic control and the risk of tuberculosis in patients with diabetes: A cohort study in a Mediterranean city |
title_short | Glycemic control and the risk of tuberculosis in patients with diabetes: A cohort study in a Mediterranean city |
title_sort | glycemic control and the risk of tuberculosis in patients with diabetes: a cohort study in a mediterranean city |
topic | Public Health |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9713231/ https://www.ncbi.nlm.nih.gov/pubmed/36466495 http://dx.doi.org/10.3389/fpubh.2022.1017024 |
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