Departments of Global Health and Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
School of Public Health, Georgia State University, Atlanta, GA.
Diabetes Care. 2022 Apr 1;45(4):880-887. doi: 10.2337/dc21-1687.
In cross-sectional U.S. studies, patients with diabetes had twice the prevalence of latent tuberculosis infection (LTBI) compared with those without diabetes. However, whether LTBI contributes to diabetes risk is unknown. We used longitudinal data to determine if LTBI is associated with increased diabetes incidence.
We conducted a retrospective cohort study among U.S. Veterans receiving care in the Veterans Health Administration from 2000 to 2015. Eligibility included all patients without preexisting diabetes who received a tuberculin skin test (TST) or interferon-γ release assay (IGRA). We excluded patients with a history of active TB and those diagnosed with diabetes before or within 2 years after LTBI testing. Patients were followed until diabetes diagnosis, death, or 2015. LTBI was defined as TST or IGRA positive. Incident diabetes was defined by use of ICD-9 codes in combination with a diabetes drug prescription.
Among 574,113 eligible patients, 5.3% received both TST/IGRA, 79.1% received TST only, and 15.6% received IGRA only. Overall, 6.6% had LTBI, and there were 2,535,149 person-years (PY) of follow-up after LTBI testing (median 3.2 years). The diabetes incidence rate (per 100,000 PY) was greater in patients with LTBI compared with those without (1,012 vs. 744; hazard ratio [HR] 1.4 [95% CI 1.3-1.4]). Increased diabetes incidence persisted after adjustment for covariates (adjusted HR [aHR] 1.2 [95% CI 1.2-1.3]) compared with those without LTBI. Among patients with LTBI, diabetes incidence was similar in those treated for LTBI compared with those who were not treated (aHR 1.0 [95% CI 0.9-1.1]).
Comprehensive longitudinal data indicate that LTBI is associated with increased diabetes incidence. These results have implications for people with LTBI, ∼25% of the global population.
在美国的横断面研究中，患有糖尿病的患者中潜伏性结核感染（LTBI）的患病率是无糖尿病患者的两倍。然而，LTBI 是否会导致糖尿病风险尚不清楚。我们使用纵向数据来确定 LTBI 是否与糖尿病发病率的增加有关。
我们在美国退伍军人事务部的退伍军人保健系统中进行了一项回顾性队列研究。纳入标准为所有无糖尿病病史且接受过结核菌素皮肤试验（TST）或干扰素-γ释放试验（IGRA）的患者。排除标准为患有活动性结核病病史或在 LTBI 检测后 2 年内被诊断患有糖尿病的患者。患者随访至糖尿病诊断、死亡或 2015 年。LTBI 定义为 TST 或 IGRA 阳性。糖尿病的发生由 ICD-9 编码与糖尿病药物处方的结合来定义。
在 574113 名符合条件的患者中，5.3%的患者同时接受了 TST/IGRA 检测，79.1%的患者仅接受了 TST 检测，15.6%的患者仅接受了 IGRA 检测。总体而言，6.6%的患者患有 LTBI，LTBI 检测后有 2535149 人年（PY）的随访（中位随访时间为 3.2 年）。与无 LTBI 的患者相比，LTBI 患者的糖尿病发病率（每 100000PY）更高（1012 比 744；风险比 [HR]1.4 [95%CI1.3-1.4]）。在校正了混杂因素后，这种增加的糖尿病发病风险仍然存在（校正 HR [aHR]1.2 [95%CI1.2-1.3]）。与无 LTBI 的患者相比，LTBI 患者中接受 LTBI 治疗的患者与未接受治疗的患者相比，糖尿病发病率相似（aHR 1.0 [95%CI0.9-1.1]）。
全面的纵向数据表明 LTBI 与糖尿病发病率的增加有关。这些结果对全球约 25%的 LTBI 人群具有重要意义。
