Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Liouying, Taiwan.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Ann Med. 2022 Dec;54(1):2470-2476. doi: 10.1080/07853890.2022.2121419.
Patients with type 2 diabetes mellitus (T2DM) are often immunosuppressed and susceptible to infectious diseases. We investigated the mortality and related risk factors of active TB disease in patients with T2DM in Taiwan.
The data of 1258 patients diagnosed with both T2DM and active TB disease from January 1 to December 31, 2002 (T2DM-TB group) were retrieved from the Taiwan National Health Insurance Research Database. Patients in the T2DM-TB group were matched by age, sex, and comorbidities to a control group of 10,064 T2DM patients without TB disease (T2DM group). Patients were followed up since TB diagnosis until death or 31 December 2011. Cox proportional-hazards regression analysis was employed to compare the risk of death between the T2DM group and the T2DM-TB group.
A total of 101,837 potentially eligible patients were included in the study. After 1:10 propensity score matching, 1,258 patients were classified in the T2DM-TB group and 10,064 patients in the T2DM group. After adjustment for age, sex and comorbidities, the T2DM-TB group showed a 2.16-fold higher mortality risk than the T2DM group (95% CI = 1.83-2.56, < .001). The mortality risk remained higher after stratification by year. The log-rank test indicated that male sex, age ≥60 years, hypertension and heart failure were independent risk factors.
TB increases mortality risk in patients with T2DM on long-term follow-up. The independent risk factors for mortality in patients with concurrent T2DM and TB disease include male sex, age ≥60 years, hypertension and heart failure.KEY MESSAGESThe co-presentation of T2DM and TB is an important emerging issue, especially in Asia.This study showed mortality risk was significantly higher in the T2DM-TB group compared with the T2DM group on long-term follow-up.Increased medical attention is necessary for patients with T2DM and a history of TB disease.
2 型糖尿病（T2DM）患者通常存在免疫抑制，易患传染病。我们调查了台湾 T2DM 患者中活动性结核病（TB）的死亡率和相关危险因素。
从 2002 年 1 月 1 日至 12 月 31 日，从台湾全民健康保险研究数据库中检索到 1258 例同时诊断为 T2DM 和活动性 TB 疾病的患者（T2DM-TB 组）的数据。将 T2DM-TB 组的患者按照年龄、性别和合并症与 10064 例无 TB 疾病的 T2DM 患者（T2DM 组）进行匹配。自 TB 诊断起对患者进行随访，直至死亡或 2011 年 12 月 31 日。采用 Cox 比例风险回归分析比较 T2DM 组和 T2DM-TB 组的死亡风险。
共有 101837 名潜在合格患者纳入研究。在进行 1:10 倾向评分匹配后，T2DM-TB 组有 1258 例患者，T2DM 组有 10064 例患者。在调整年龄、性别和合并症后，T2DM-TB 组的死亡率风险比 T2DM 组高 2.16 倍（95%CI=1.83-2.56，<0.001）。分层分析后，各年的死亡率风险仍较高。对数秩检验表明，男性、年龄≥60 岁、高血压和心力衰竭是独立的危险因素。
在长期随访中，TB 会增加 T2DM 患者的死亡风险。同时患有 T2DM 和 TB 疾病的患者的死亡独立危险因素包括男性、年龄≥60 岁、高血压和心力衰竭。
T2DM 和 TB 同时存在是一个重要的新出现问题，尤其是在亚洲。本研究表明，在长期随访中，T2DM-TB 组的死亡率明显高于 T2DM 组。对于有 TB 病史的 T2DM 患者，需要加强医疗关注。
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