Diabetes as a risk factor for tuberculosis disease.

Area of Science:

• Public Health
• Epidemiology
• Infectious Disease Research

Background:

• Tuberculosis (TB) remains a leading infectious cause of death, with 10.6 million cases in 2022.
• Diabetes mellitus (DM) is increasingly recognized as a significant risk factor influencing TB incidence, mortality, relapse, and drug resistance.

Purpose of the Study:

• To evaluate the prognostic value of diabetes mellitus in predicting tuberculosis disease across diverse populations, including adults, adolescents, and children.

Main Methods:

• A systematic literature search was conducted across major databases (PubMed, WHO Global Index Medicus, ICTRP) for cohort studies.
• Included studies encompassed retrospective and prospective designs, assessing diabetes status at baseline and TB incidence/recurrence as outcomes.
• Meta-analysis of adjusted hazard ratios, risk ratios, and odds ratios was performed using random-effects models, with evidence certainty rated by GRADE.

Main Results:

• Analysis of 48 cohort studies (over 61 million participants) indicated that DM increases the risk of TB disease (HR 1.90, low certainty).
• The risk was more consistent for follow-up < 10 years (HR 1.52, moderate certainty), but higher for ≥ 10 years (HR 2.44, low certainty).
• DM also increased the odds (OR 1.61, low certainty) and risk (RR 1.60, moderate certainty) of TB disease.

Conclusions:

• Diabetes mellitus is a probable risk factor for developing TB disease in both the short and long term.
• Integrated policies addressing diabetes management are crucial for achieving global TB control targets.
• Further large-scale, high-quality cohort studies, particularly in underrepresented regions and including children/adolescents, are needed.