Diabetic patients with poor glycemic control had an increased risk of developing tuberculosis, while those with good glycemic control showed no significantly different risk compared to non-diabetic population. These findings published in PLOS Medicine suggest the crucial role of diabetic control in combating tuberculosis. This study was conducted by the research team of Dr. Hsien-Ho Lin, from the College of Public Health at National Taiwan University.
Over 120,000 participants of a health screening program in northern Taiwan were enrolled in this study from 2005 to 2008. Fasting plasma glucose, a clinical indicator measured at the screening service, was used to define the level of glycemic control. With a fasting glucose value higher than 130 mg/dl, diabetic patients were categorized to the group of poor glycemic control. The participants were followed up for a median period of 4.6 years to observe the incidence of tuberculosis. The researchers found that diabetic patients with poor glycemic control had a two-fold increase in tuberculosis risk compared with non-diabetic individuals. On the other hand, diabetic patients with good control had a similar risk of tuberculosis as the non-diabetics. In the dose-response analysis, the risk of tuberculosis elevated linearly by 6% for every 10 mg/dl increase in fasting glucose.
‘‘Assuming that these findings imply a causal effect of glycemic control on tuberculosis, 7.5% of incident tuberculosis cases could be prevented if all diabetic patients in the study population achieved good glycemic control.’’, report the research team in the published article. They investigated the potential impact of the study finding in a counterfactual scenario that assumes relevant interventions are taken to maintain glycemic control.
Diabetes and tuberculosis is the dual epidemic that requires collaborative management and control measures to tackle. A previous modeling study by the same research team revealed that preventing diabetes may make a profound contribution to tuberculosis control in the near future. Providing further evidence, the current study demonstrates the beneficial effect of glycemic control on the risk of tuberculosis. This again highlights the importance of integrating programs of noncommunicable and communicable diseases in order to effectively alleviate the overall health burden.