Glycemic control and the risk of tuberculosis in patients with diabetes: A cohort study in a Mediterranean city
Por:
Antonio-Arques, V, Cayla, JA, Real, J, Moreno-Martinez, A, Orcau, A, Mauricio, D, Mata-Cases, M, Julve, J, Mendez, EN, Treserra, RP, Millet, JP, Garcia, JLD, Vlacho, B, Franch-Nadal, J
Publicada:
17 nov 2022
Resumen:
BackgroundDiabetes 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. MethodsWe 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. ResultsOf 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. ConclusionDiabetic subjects with worse glycemic control show a trend toward a higher risk of developing TB.
Filiaciones:
Antonio-Arques, V:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Unitat Suport La Recerca Barcelona, DAP Cat Grp, Barcelona, Spain
Inst Catala Salut, Primary Hlth Care Ctr La Rapita Alcanar, Gerencia Atencio Primaria Terres Ebre, Tortosa, Spain
Cayla, JA:
TB Res Unit Fdn Barcelona, Barcelona, Spain
Real, J:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Unitat Suport La Recerca Barcelona, DAP Cat Grp, Barcelona, Spain
Inst Salud Carlos III, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Moreno-Martinez, A:
Hosp Clin Barcelona, Dept Infect Dis, Barcelona, Spain
Inst Salud Carlos III ISCIII, CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain
Orcau, A:
Inst Salud Carlos III ISCIII, CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Mauricio, D:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Unitat Suport La Recerca Barcelona, DAP Cat Grp, Barcelona, Spain
Inst Salud Carlos III, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Hosp Univ Santa Creu & St Pau, Dept Endocrinol & Nutr, Barcelona, Spain
Univ Vic Cent Univ Catalonia, Dept Med, Barcelona, Spain
Mata-Cases, M:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Unitat Suport La Recerca Barcelona, DAP Cat Grp, Barcelona, Spain
Inst Salud Carlos III, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Inst Catala Salut, Primary Hlth Care Ctr La Mina, Gerencia Atencio Primaria Barcelona Ciutat, Barcelona, Spain
Julve, J:
Inst Salud Carlos III, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Hosp Santa Creu & Sant Pau, Dept Biochem, Inst Recerca, Barcelona, Spain
Mendez, EN:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Barcelona, Spain
Treserra, RP:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Unitat Suport La Recerca Barcelona, DAP Cat Grp, Barcelona, Spain
Millet, JP:
Inst Salud Carlos III ISCIII, CIBER Epidemiol & Publ Hlth CIBERESP, Madrid, Spain
Agencia Salut Publ Barcelona, Epidemiol Serv, Barcelona, Spain
Garcia, JLD:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Barcelona, Spain
Inst Catala Salut, Unitat Avaluacio Sistemes Informacio & Qualitat, Gerencia Ambit Atencio Primaria Barcelona Ciuta, Barcelona, Spain
Vlacho, B:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Unitat Suport La Recerca Barcelona, DAP Cat Grp, Barcelona, Spain
Franch-Nadal, J:
Fundacio Inst Univ Recerca Atencio Primaria Salut, Unitat Suport La Recerca Barcelona, DAP Cat Grp, Barcelona, Spain
Inst Salud Carlos III, CIBER Diabet & Associated Metab Dis CIBERDEM, Madrid, Spain
Inst Catala Salut, Primary Hlth Care Ctr Raval Sud, Gerencia Atencio Primaria Barcelona Ciutat, Barcelona, Spain
gold, Green Published, All Open Access, Gold, Green
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