Glycemic Control and the Risk of Tuberculosis: A Cohort Study

Pin Hui Lee, Han Fu, Ting Chun Lai, Chen Yuan Chiang, Chang Chuan Chan, Hsien Ho Lin

Research output: Contribution to journalArticle

27 Citations (Scopus)

Abstract

Background: Diabetes is a well-known risk factor for tuberculosis (TB) and is increasingly prevalent in low- and middle-income countries, where the burden of TB is high. Glycemic control has the potential to modify the risk of TB. However, there are few studies on the association between glycemic control and TB risk, and the results are inconsistent. Methods and Findings: We assembled a cohort using 123,546 individuals who participated in a community-based health screening service in northern Taiwan from 5 March 2005 to 27 July 2008. Glycemic control was measured using fasting plasma glucose (FPG) at the time of screening. The cohort was followed up to 31 December 2012 for the occurrence of TB by cross-matching the screening database to the national health insurance database. Multiple imputation was used to handle missing information. During a median follow-up of 4.6 y, 327 cases of TB occurred. In the multivariable Cox regression model, diabetic patients with poor glycemic control (FPG > 130 mg/dl) had a significantly higher hazard of TB (adjusted hazard ratio [aHR] 2.21, 95% CI 1.63–2.99, p < 0.001) compared to those without diabetes. The hazard of TB in diabetic patients with good glycemic control (FPG ≤ 130 mg/dl) did not differ significantly from that in nondiabetic individuals (aHR 0.69, 95% CI 0.35–1.36, p = 0.281). In the linear dose-response analysis, the hazard of TB increased with FPG (aHR 1.06 per 10-mg/dl increase in FPG, 95% CI 1.03–1.08, p < 0.001). Assuming the observed association between glycemic control and TB was causal, an estimated 7.5% (95% CI 4.1%–11.5%) of incident TB in the study population could be attributed to poor glycemic control. Limitations of the study include one-time measurement of fasting glucose at baseline and voluntary participation in the health screening service. Conclusions: Good glycemic control could potentially modify the risk of TB among diabetic patients and may contribute to the control of TB in settings where diabetes and TB are prevalent.

Original languageEnglish
Article numbere1002072
JournalPLoS Medicine
Volume13
Issue number8
DOIs
Publication statusPublished - Aug 1 2016
Externally publishedYes

Fingerprint

Tuberculosis
Cohort Studies
Hazards
Glucose
Plasmas
Screening
Fasting
Medical problems
Health
Health insurance
Health Services
Time measurement
Databases
National Health Programs
Taiwan
Proportional Hazards Models

ASJC Scopus subject areas

  • Biotechnology
  • Biochemistry
  • Molecular Biology
  • Cell Biology

Cite this

Lee, P. H., Fu, H., Lai, T. C., Chiang, C. Y., Chan, C. C., & Lin, H. H. (2016). Glycemic Control and the Risk of Tuberculosis: A Cohort Study. PLoS Medicine, 13(8), [e1002072]. https://doi.org/10.1371/journal.pmed.1002072

Glycemic Control and the Risk of Tuberculosis : A Cohort Study. / Lee, Pin Hui; Fu, Han; Lai, Ting Chun; Chiang, Chen Yuan; Chan, Chang Chuan; Lin, Hsien Ho.

In: PLoS Medicine, Vol. 13, No. 8, e1002072, 01.08.2016.

Research output: Contribution to journalArticle

Lee, Pin Hui ; Fu, Han ; Lai, Ting Chun ; Chiang, Chen Yuan ; Chan, Chang Chuan ; Lin, Hsien Ho. / Glycemic Control and the Risk of Tuberculosis : A Cohort Study. In: PLoS Medicine. 2016 ; Vol. 13, No. 8.
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abstract = "Background: Diabetes is a well-known risk factor for tuberculosis (TB) and is increasingly prevalent in low- and middle-income countries, where the burden of TB is high. Glycemic control has the potential to modify the risk of TB. However, there are few studies on the association between glycemic control and TB risk, and the results are inconsistent. Methods and Findings: We assembled a cohort using 123,546 individuals who participated in a community-based health screening service in northern Taiwan from 5 March 2005 to 27 July 2008. Glycemic control was measured using fasting plasma glucose (FPG) at the time of screening. The cohort was followed up to 31 December 2012 for the occurrence of TB by cross-matching the screening database to the national health insurance database. Multiple imputation was used to handle missing information. During a median follow-up of 4.6 y, 327 cases of TB occurred. In the multivariable Cox regression model, diabetic patients with poor glycemic control (FPG > 130 mg/dl) had a significantly higher hazard of TB (adjusted hazard ratio [aHR] 2.21, 95{\%} CI 1.63–2.99, p < 0.001) compared to those without diabetes. The hazard of TB in diabetic patients with good glycemic control (FPG ≤ 130 mg/dl) did not differ significantly from that in nondiabetic individuals (aHR 0.69, 95{\%} CI 0.35–1.36, p = 0.281). In the linear dose-response analysis, the hazard of TB increased with FPG (aHR 1.06 per 10-mg/dl increase in FPG, 95{\%} CI 1.03–1.08, p < 0.001). Assuming the observed association between glycemic control and TB was causal, an estimated 7.5{\%} (95{\%} CI 4.1{\%}–11.5{\%}) of incident TB in the study population could be attributed to poor glycemic control. Limitations of the study include one-time measurement of fasting glucose at baseline and voluntary participation in the health screening service. Conclusions: Good glycemic control could potentially modify the risk of TB among diabetic patients and may contribute to the control of TB in settings where diabetes and TB are prevalent.",
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AU - Lin, Hsien Ho

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N2 - Background: Diabetes is a well-known risk factor for tuberculosis (TB) and is increasingly prevalent in low- and middle-income countries, where the burden of TB is high. Glycemic control has the potential to modify the risk of TB. However, there are few studies on the association between glycemic control and TB risk, and the results are inconsistent. Methods and Findings: We assembled a cohort using 123,546 individuals who participated in a community-based health screening service in northern Taiwan from 5 March 2005 to 27 July 2008. Glycemic control was measured using fasting plasma glucose (FPG) at the time of screening. The cohort was followed up to 31 December 2012 for the occurrence of TB by cross-matching the screening database to the national health insurance database. Multiple imputation was used to handle missing information. During a median follow-up of 4.6 y, 327 cases of TB occurred. In the multivariable Cox regression model, diabetic patients with poor glycemic control (FPG > 130 mg/dl) had a significantly higher hazard of TB (adjusted hazard ratio [aHR] 2.21, 95% CI 1.63–2.99, p < 0.001) compared to those without diabetes. The hazard of TB in diabetic patients with good glycemic control (FPG ≤ 130 mg/dl) did not differ significantly from that in nondiabetic individuals (aHR 0.69, 95% CI 0.35–1.36, p = 0.281). In the linear dose-response analysis, the hazard of TB increased with FPG (aHR 1.06 per 10-mg/dl increase in FPG, 95% CI 1.03–1.08, p < 0.001). Assuming the observed association between glycemic control and TB was causal, an estimated 7.5% (95% CI 4.1%–11.5%) of incident TB in the study population could be attributed to poor glycemic control. Limitations of the study include one-time measurement of fasting glucose at baseline and voluntary participation in the health screening service. Conclusions: Good glycemic control could potentially modify the risk of TB among diabetic patients and may contribute to the control of TB in settings where diabetes and TB are prevalent.

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