Division of Pulmonology, Department of Internal Medicine, Cheju Halla General Hospital, Jeju, 63127, Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, 06978, Korea.
Respir Res. 2023 Apr 11;24(1):110. doi: 10.1186/s12931-023-02414-5.
Many have the rising coincidence of diabetes mellitus (DM) and endemic tuberculosis (TB). We evaluated whether the severity of diabetes is associated with an increased risk of active TB infection.
Using a nationally representative database from the Korean National Health Insurance System, 2, 489, 718 people with type 2 DM who underwent a regular health checkup during 2009-2012 were followed up until the end of 2018. The diabetes severity score parameters included the number of oral hypoglycemic agents (≥ 3), insulin use, diabetes duration (≥ 5 years), and the presence of chronic kidney disease (CKD) or cardiovascular disease. Each of these characteristics was scored as one point, and their sum (0-5) was used as the diabetes severity score.
We identified 21, 231 cases of active TB during a median follow-up of 6.8 years. Each parameter of the diabetes severity score was associated with an increased risk of active TB (all P < 0.001). Insulin use was the most significant factor related to the risk of TB, followed by CKD. The risk of TB increased progressively with increasing diabetes severity score. After adjusting for possible confounding factors, the hazard ratio (95% confidence interval) for TB were 1.23 (1.19-1.27) in participants with one parameter, 1.39 (1.33-1.44) in those with two parameters, 1.65 (1.56-1.73) in those with three parameters, 2.05 (1.88-2.23) in those with four parameters, and 2.62 (2.10-3.27) in those with five parameters compared with participants with no parameters.
Diabetes severity was strongly associated in a dose-dependent manner with the occurrence of active TB. People with a higher diabetes severity score may be a targeted group for active TB screening.
糖尿病（DM）和地方性结核病（TB）的发病率不断上升。我们评估了糖尿病的严重程度是否与活动性 TB 感染风险增加有关。
利用韩国国家健康保险系统的全国代表性数据库，对 2009 年至 2012 年期间接受定期健康检查的 2489718 例 2 型糖尿病患者进行随访，随访至 2018 年底。糖尿病严重程度评分参数包括口服降糖药数量（≥3）、胰岛素使用、糖尿病病程（≥5 年）和慢性肾脏病（CKD）或心血管疾病的存在。每个特征记 1 分，总分（0-5）为糖尿病严重程度评分。
我们在中位随访 6.8 年期间确定了 21231 例活动性 TB 病例。糖尿病严重程度评分的每个参数均与活动性 TB 风险增加相关（均 P<0.001）。胰岛素使用是与 TB 风险相关的最显著因素，其次是 CKD。随着糖尿病严重程度评分的增加，TB 的风险逐渐增加。在调整可能的混杂因素后，与无参数组相比，一个参数组的 TB 发病风险比（95%置信区间）为 1.23（1.19-1.27），两个参数组为 1.39（1.33-1.44），三个参数组为 1.65（1.56-1.73），四个参数组为 2.05（1.88-2.23），五个参数组为 2.62（2.10-3.27）。
糖尿病严重程度与活动性 TB 的发生呈剂量依赖性相关。糖尿病严重程度评分较高的患者可能是活动性 TB 筛查的目标人群。
