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Association between diabetes mellitus and active tuberculosis: A systematic review and meta-analysis.

Al-Rifai, RH; Pearson, F; Critchley, JA; Abu-Raddad, LJ (2017) Association between diabetes mellitus and active tuberculosis: A systematic review and meta-analysis. PLoS One, 12 (11). e0187967. ISSN 1932-6203 https://doi.org/10.1371/journal.pone.0187967
SGUL Authors: Critchley, Julia

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Abstract

The burgeoning epidemic of diabetes mellitus (DM) is one of the major global health challenges. We systematically reviewed the published literature to provide a summary estimate of the association between DM and active tuberculosis (TB). We searched Medline and EMBASE databases for studies reporting adjusted estimates on the TB-DM association published before December 22, 2015, with no restrictions on region and language. In the meta-analysis, adjusted estimates were pooled using a DerSimonian-Laird random-effects model, according to study design. Risk of bias assessment and sensitivity analyses were conducted. 44 eligible studies were included, which consisted of 58,468,404 subjects from 16 countries. Compared with non-DM patients, DM patients had 3.59-fold (95% confidence interval (CI) 2.25-5.73), 1.55-fold (95% CI 1.39-1.72), and 2.09-fold (95% CI 1.71-2.55) increased risk of active TB in four prospective, 16 retrospective, and 17 case-control studies, respectively. Country income level (3.16-fold in low/middle-vs. 1.73-fold in high-income countries), background TB incidence (2.05-fold in countries with >50 vs. 1.89-fold in countries with ≤50 TB cases per 100,000 person-year), and geographical region (2.44-fold in Asia vs. 1.71-fold in Europe and 1.73-fold in USA/Canada) affected appreciably the estimated association, but potential risk of bias, type of population (general versus clinical), and potential for duplicate data, did not. Microbiological ascertainment for TB (3.03-fold) and/or blood testing for DM (3.10-fold), as well as uncontrolled DM (3.30-fold), resulted in stronger estimated association. DM is associated with a two- to four-fold increased risk of active TB. The association was stronger when ascertainment was based on biological testing rather than medical records or self-report. The burgeoning DM epidemic could impact upon the achievements of the WHO "End TB Strategy" for reducing TB incidence.

Item Type: Article
Additional Information: © 2017 Al-Rifai et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Keywords: Asia, Canada, Diabetes Complications, Diabetes Mellitus, Europe, Humans, Risk Factors, Tuberculosis, General Science & Technology, MD Multidisciplinary
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: PLoS One
ISSN: 1932-6203
Language: eng
Dates:
DateEvent
21 November 2017Published
30 October 2017Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
7-627-3-167Qatar Foundationhttp://dx.doi.org/10.13039/100007458
PubMed ID: 29161276
Go to PubMed abstract
URI: https://openaccess.sgul.ac.uk/id/eprint/109254
Publisher's version: https://doi.org/10.1371/journal.pone.0187967

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