Diabetes Mellitus Increases the Risk of Recurrent Tuberculosis: A Population-based Nested Case-control Study

• Main Authors: Pin-Hui Lee, 李品慧
• Other Authors: 林先和
• Format: Others
• Language: en_US
• Published: 2012
• Online Access: http://ndltd.ncl.edu.tw/handle/42w5pz

碩士 === 國立臺灣大學 === 流行病學與預防醫學研究所 === 100 === Background Diabetes mellitus increases the risk of developing tuberculosis (TB), and is associated with unfavorable treatment outcomes, including treatment failure and death. It remains unclear whether diabetes also increases the risk of TB recurrence among those who had completed treatment. Methods We analyzed the national data from TB registry to estimate the incidence of recurrent TB recurrence rate among the 2006-2007 cohort of incident TB cases in Taiwan. Under the same cohort, we conducted a nested case-control study to investigate the association between DM status during previous anti-TB treatment and subsequent recurrence of TB. The study population, all confirmed pulmonary TB cases reported to Taiwan TB registry during 2006 to 2007 with completing treatment outcome, was followed till December 31, 2010. Recurrent cases were defined as illnesses in patients with recurrent bacteriological or pathological confirmation of TB after having completed previous anti-TB treatment. For case-control analysis, controls were selected from the study population with 1:1 ratio to cases using incidence-density sampling and matched on time since treatment completion. Demographic and clinical characteristics of previous TB episodes were collected through retrospective medical charts review and TB registration database. We used conditional logistic regression analysis to measure the association between diabetes and recurrent TB. Results There were 305 (1.4%) cases of recurrent TB among the 21,939 pulmonary TB patients enrolled; two hundred and fifty one matched case-control pairs were analyzed after excluding missing information. The estimated incidence of recurrent TB among the 2006-2007 cohort was 487.6/100,000 person year (434.4-545.5/100,000). The presence of diabetes during previous TB treatment increased the risk of TB recurrence (crude OR= 1.74, 95% CI: 1.18 - 2.59). The association remained unchanged after adjusting for gender, indigenous population, alcohol consumption, smoking, cancer, end-stage of renal disease, coexisting of extra-pulmonary lesion, initial cavitation, suboptimal regimen, and directly observed therapy over 60% of treatment duration (adjusted OR= 1.84, 95% CI: 1.14-2.98). Conclusions The presence of diabetes mellitus was independently associated with increased risk of developing recurrent TB. To prevent recurrent TB among this population, further studies are needed to understand whether improved glycemic control during anti-TB treatment decreases the risk of recurrence.