Sane Schepisi Monica, Navarra Assunta, Altet Gomez M Nieves, Dudnyk Andrii, Dyrhol-Riise Anne Margarita, Esteban Jaime, Giorgetti Pier Francesco, Gualano Gina, Guglielmetti Lorenzo, Heyckendorf Jan, Kaluzhenina Anna, Lange Berit, Lange Christoph, Manika Katerina, Miah Jalal, Nanovic Zorica, Pontali Emanuele, Prego Monica Rios, Solovic Ivan, Tiberi Simon, Palmieri Fabrizio, Girardi Enrico
Clinical Epidemiology Unit, National Institute for Infectious Diseases L. Spallanzani - IRCCS, Rome, Italy.
Unidad de Tratamiento Directamente Observado de la Tuberculosis "Servicios Clínicos," Barcelona, Spain.
Open Forum Infect Dis. 2018 Dec 19;6(1):ofy337. doi: 10.1093/ofid/ofy337. eCollection 2019 Jan.
The growing burden of diabetes mellitus (DM) is posing a threat to global tuberculosis (TB) control. DM triples the risk of developing TB, modifies the presenting features of pulmonary TB, and worsens TB treatment outcomes. We aimed to analyze the prevalence of DM among TB patients and to describe the characteristics and clinical presentation of TB-DM patients in Europe.
We performed a cross-sectional survey on the prevalence of DM among consecutively diagnosed adult TB patients in 11 European TB referral centers located in France, Germany, Greece, Italy, Russia, Slovakia, Spain, and the United Kingdom over the period 2007-2015. We also selected DM-TB cases and TB only controls with a 1:3 ratio to perform a case-control analysis, including patients selected from the countries mentioned above plus Norway and Ukraine.
Among 3143 TB enrolled patients, DM prevalence overall was 10.7% and ranged from 4.4% in Greece to 28.5% in the United Kingdom. Patients' median ages ranged from 36 to 49 years, and all centers had >60% males; the proportion of foreign-born patients varied widely across sites. In the case-control study, DM was independently associated with older age and, among older patients, with being foreign-born. Among patients with pulmonary involvement, cavities on chest imaging were more frequently observed among those with DM.
Diabetes mellitus represents a challenge for TB control in Europe, especially in foreign-born and in elderly patients. Specific screening strategies should be evaluated.
糖尿病（DM）负担的不断加重对全球结核病（TB）控制构成了威胁。糖尿病使患结核病的风险增加两倍，改变了肺结核的临床表现，并使结核病治疗结果恶化。我们旨在分析结核病患者中糖尿病的患病率，并描述欧洲结核病合并糖尿病患者的特征和临床表现。
我们对2007年至2015年期间位于法国、德国、希腊、意大利、俄罗斯、斯洛伐克、西班牙和英国的11个欧洲结核病转诊中心连续诊断的成年结核病患者中糖尿病的患病率进行了横断面调查。我们还以1:3的比例选择了糖尿病合并结核病病例和单纯结核病对照进行病例对照分析，包括从上述国家以及挪威和乌克兰选取的患者。
在3143名登记的结核病患者中，糖尿病总体患病率为10.7%，范围从希腊的4.4%到英国的28.5%。患者的年龄中位数在36至49岁之间，所有中心男性比例均超过60%；外国出生患者的比例在各地点差异很大。在病例对照研究中，糖尿病与年龄较大独立相关，在老年患者中，与外国出生相关。在有肺部受累的患者中，糖尿病患者胸部影像学上的空洞更常见。
糖尿病对欧洲的结核病控制构成挑战，尤其是在外国出生者和老年患者中。应评估具体的筛查策略。
