糖尿病对高结核病负担 13 国结核病控制的影响：建模研究。
Effect of diabetes on tuberculosis control in 13 countries with high tuberculosis: a modelling study.
机构信息
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
出版信息
Lancet Diabetes Endocrinol. 2015 May;3(5):323-30. doi: 10.1016/S2213-8587(15)00042-X. Epub 2015 Mar 6.
BACKGROUND
Diabetes increases the risk of tuberculosis incidence and the risk of adverse treatment outcomes in patients with tuberculosis. Because prevalence of diabetes is increasing in low-income and middle-income countries where the burden of tuberculosis is high, prevention of diabetes carries the potential to improve tuberculosis control worldwide.
METHODS
We used dynamic tuberculosis transmission models to analyse the potential effect of diabetes on tuberculosis epidemiology in 13 countries with high tuberculosis burden. We used data for previous diabetes prevalence in each country and constructed scenarios to represent the potential ranges of future diabetes prevalence. The country-specific model was calibrated to the estimated trend of tuberculosis incidence. We estimated the tuberculosis burden that can be reduced by alternative scenarios of diabetes prevention.
FINDINGS
If the prevalence of diabetes continues to rise as it has been in the past decade in the 13 countries (base case scenario), by 2035, the cumulative reduction in tuberculosis incidence would be 8·8% (95% credible interval [CrI] 4·0-15·8) and mortality would be 34·0% (30·3-39·6). Lowering the prevalence of diabetes by an absolute level of 6·6-13·8% could accelerate the decline of tuberculosis incidence by an absolute level of 11·5-25·2% and tuberculosis mortality by 8·7-19·4%. Compared with the base case scenario, stopping the rise of diabetes would avoid 6·0 million (95% CrI 5·1-6·9) incident cases and 1·1 million (1·0-1·3) tuberculosis deaths in 13 countries during 20 years. If interventions reduce diabetes incidence by 35% by 2025, 7·8 million (6·7-9·0) tuberculosis cases and 1·5 million (1·3-1·7) tuberculosis deaths could be averted by 2035.
INTERPRETATION
The diabetes epidemic could substantially affect tuberculosis epidemiology in high burden countries. The communicable disease and non-communicable disease sectors need to move beyond conventional boundaries and link with each other to form a joint response to diabetes and tuberculosis.
FUNDING
Taiwan National Science Council.
背景
糖尿病会增加结核病发病率和结核病患者不良治疗结局的风险。由于在结核病负担沉重的低收入和中等收入国家，糖尿病的患病率正在上升，因此预防糖尿病有可能改善全球结核病控制。
方法
我们使用动态结核病传播模型分析了糖尿病对 13 个结核病负担沉重国家结核病流行病学的潜在影响。我们使用了每个国家以前的糖尿病患病率数据，并构建了一些情景来代表未来糖尿病患病率的潜在范围。针对每个国家的模型都根据结核病发病率的估计趋势进行了校准。我们估算了通过替代糖尿病预防情景可以减少的结核病负担。
发现
如果 13 个国家的糖尿病患病率像过去十年那样持续上升（基础情况），到 2035 年，结核病发病率的累计降幅将为 8.8%（95%置信区间 4.0-15.8），死亡率将下降 34.0%（30.3-39.6）。将糖尿病患病率降低绝对水平 6.6-13.8%，可以使结核病发病率的绝对降幅提高 11.5-25.2%，结核病死亡率降低 8.7-19.4%。与基础情况相比，在 13 个国家中，停止糖尿病发病率的上升可以避免 600 万（95%置信区间 5.1-6.9）例新发病例和 110 万（1.0-1.3）例结核病死亡。如果干预措施在 2025 年使糖尿病发病率降低 35%，到 2035 年，将可以避免 780 万（6.7-9.0）例结核病病例和 150 万（1.3-1.7）例结核病死亡。
解释
糖尿病流行可能会对高负担国家的结核病流行病学产生重大影响。传染病和非传染病部门需要超越传统界限，相互联系，形成防治糖尿病和结核病的联合应对措施。
资助
台湾国家科学委员会。
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