Abstract:

Objective: To investigate the incidence and determinants of tuberculosis among community-dwelling patients with type 2 diabetes, aiming to establish a theoretical foundation for developing integrated prevention and treatment strategies for this comorbidity. Methods: This retrospective cohort study involved 20053 community-dwelling type 2 diabetes patients aged 35 and above, registered in the basic public health service management systems of Changshu City, Qingjiangpu District, and Huai’an District of Jiangsu Province from December 2013 to December 2019. Using the Tuberculosis Management Information System, we matched the data of newly diagnosed tuberculosis patients during the same period to identify affected individuals within the study cohort. A nested case-control study was established, matching non-tuberculosis patients to tuberculosis patients using a 1∶4 propensity score. Multivariate logistic regression was employed to analyze factors influencing the incidence of tuberculosis among type 2 diabetes patients in the community. Results: Among the 20053 diabetic patients studied, there were 123 new cases of tuberculosis, including 4 extrapulmonary cases. The cumulative incidence rate was 613.37 per 100000 (123/20053), with an average annual incidence of 102.23 per 100000 (20.5/20053). The cumulative incidence was significantly higher in males at 1119.31 per 100000 (88/7862) compared to females at 287.10 per 100000 (35/12191), with a statistically significant difference (χ²=54.301, P<0.001). Additionally, rural residents exhibited a higher cumulative incidence rate of 718.93 per 100000 (83/11545) compared to urban residents at 470.15 per 100000, also statistically significant (χ²=4.973, P=0.026). Multivariate logistic regression analysis identified an increased body mass index as a protective factor against tuberculosis among diabetic patients, with an odds ratio (OR) of 0.422 (95%CI: 0.288-0.617). In contrast, elevated levels of glycosylated hemoglobin (OR=2.019, 95%CI: 1.195-3.410) and urea (OR=1.727, 95%CI: 1.121-2.661) emerged as significant risk factors for tuberculosis. Furthermore, analysis from 2013 to 2019 revealed a negative correlation between the mean years to TB onset and increased fasting blood glucose (r=-0.130) in the TB cohort. Conclusion: This study demonstrates that the cumulative incidence of tuberculosis among community-dwelling type 2 diabetes patients is substantially higher than the general population during the same period. It underscores the necessity of targeting interventions towards diabetic patients with suboptimal glycemic control and related complications to mitigate their elevated risk of tuberculosis.

Key words: Diabetes mellitus,type 2, Tuberculosis, Factor analysis, statistical