Case Control Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Feb 15, 2024; 15(2): 196-208
Published online Feb 15, 2024. doi: 10.4239/wjd.v15.i2.196
Analysis of the influencing factors and clinical related characteristics of pulmonary tuberculosis in patients with type 2 diabetes mellitus
Han Shi, Yuan Yuan, Xue Li, Yan-Fang Li, Ling Fan, Xue-Mei Yang
Han Shi, Yuan Yuan, Xue Li, Yan-Fang Li, Ling Fan, Xue-Mei Yang, Department of Infectious Diseases, The First Affiliated Hospital of Chengdu Medical College, Chengdu 610500, Sichuan Province, China
Co-first authors: Han Shi and Yuan Yuan.
Author contributions: Shi H and Yuan Y designed the research; and Shi H and Yuan Y contributed equally to this work as co-first authors equally to this work; Li X, Yuan Y, Li YF, Fan L, Yang XM and Shi H contributed new reagents/analytic tools; Yuan Y, Li X, Li YF, Fan L, Yang YM and Shi H analyzed the data; Shi H and Yuan Y wrote the paper; and all authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript.
Institutional review board statement: This study protocol was approved by The First Affiliated Hospital of Chengdu Medical College.
Informed consent statement: All the families have voluntarily participated in the study and have signed informed consent forms.
Conflict-of-interest statement: The authors declared no conflict of interest existing in this paper.
Data sharing statement: Data generated from this investigation are available upon reasonable quest from the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuan Yuan, MM, Associate Chief Physician, Department of Infectious Diseases, The First Affiliated Hospital of Chengdu Medical College, No. 278 Middle Section of Baoguang Avenue, Xindu District, Chengdu 610500, Sichuan Province, China. cyfygrk2270@163.com
Received: October 30, 2023
Peer-review started: October 30, 2023
First decision: November 8, 2023
Revised: December 14, 2023
Accepted: January 18, 2024
Article in press: January 18, 2024
Published online: February 15, 2024
Processing time: 97 Days and 2.1 Hours
Abstract
BACKGROUND

In China, the prevalence of type 2 diabetes mellitus (T2DM) among diabetic patients is estimated to be between 90%-95%. Additionally, China is among the 22 countries burdened by a high number of tuberculosis cases, with approximately 4.5 million individuals affected by active tuberculosis. Notably, T2DM poses a significant risk factor for the development of tuberculosis, as evidenced by the increased incidence of T2DM coexisting with pulmonary tuberculosis (T2DM-PTB), which has risen from 19.3% to 24.1%. It is evident that these two diseases are intricately interconnected and mutually reinforcing in nature.

AIM

To elucidate the clinical features of individuals diagnosed with both T2DM and tuberculosis (T2DM-PTB), as well as to investigate the potential risk factors associated with active tuberculosis in patients with T2DM.

METHODS

T2DM-PTB patients who visited our hospital between January 2020 and January 2023 were selected as the observation group, Simple DM patients presenting to our hospital in the same period were the control group, Controls and case groups were matched 1:2 according to the principle of the same sex, age difference ( ± 3) years and disease duration difference ( ± 5) years, patients were investigated for general demographic characteristics, diabetes-related characteristics, body immune status, lifestyle and behavioral habits, univariate and multivariate analysis of the data using conditional logistic regression, calculate the odds ratio (OR) values and 95%CI of OR values.

RESULTS

A total of 315 study subjects were included in this study, including 105 subjects in the observation group and 210 subjects in the control group. Comparison of the results of both anthropometric and biochemical measures showed that the constitution index, systolic blood pressure, diastolic blood pressure and lymphocyte count were significantly lower in the case group, while fasting blood glucose and high-density lipoprotein cholesterol levels were significantly higher than those in the control group. The results of univariate analysis showed that poor glucose control, hypoproteinemia, lymphopenia, TB contact history, high infection, smoking and alcohol consumption were positively associated with PTB in T2DM patients; married, history of hypertension, treatment of oral hypoglycemic drugs plus insulin, overweight, obesity and regular exercise were negatively associated with PTB in T2DM patients. Results of multivariate stepwise regression analysis found lymphopenia (OR = 17.75, 95%CI: 3.40-92.74), smoking (OR = 12.25, 95%CI: 2.53-59.37), history of TB contact (OR = 6.56, 95%CI: 1.23-35.03) and poor glycemic control (OR = 3.37, 95%CI: 1.11-10.25) was associated with an increased risk of developing PTB in patients with T2DM, While being overweight (OR = 0.23, 95%CI: 0.08-0.72) and obesity (OR = 0.11, 95%CI: 0.02-0.72) was associated with a reduced risk of developing PTB in patients with T2DM.

CONCLUSION

T2DM-PTB patients are prone to worse glycemic control, higher infection frequency, and a higher proportion of people smoking, drinking alcohol, and lack of exercise. Lymphopenia, smoking, history of TB exposure, poor glycemic control were independent risk factors for T2DM-PTB, and overweight and obesity were associated with reduced risk of concurrent PTB in patients with T2DM.

Keywords: Type 2 diabetes; Pulmonary tuberculosis; Blood sugar; Infection; Risk factors

Core Tip: Diabetes mellitus is a metabolic disorder resulting from a combination of genetic factors, environmental influences, and lifestyle choices, which lead to impairments in insulin secretion or function. In recent times, there has been a significant increase in the incidence of diabetes accompanied by hyperglycemia as its primary manifestation. By conducting case-control studies within hospital settings, we aim to examine the distinctive features of patients with type 2 diabetes mellitus and pulmonary tuberculosis and investigate the potential risk factors associated with the development of tuberculosis in this specific population.