Objectives
Increased adiposity is a major risk factor for diabetes mellitus (DM) and pre-diabetes. Tuberculosis (TB) is associated with wasting and altered body composition. As dual epidemics of communicable and non-communicable diseases collide in many settings including India, little is known about the interplay of TB and disordered glucose metabolism among patients with lower body weight.
Methods
Adult outpatients (= 18 years) presenting with clinical signs and symptoms of tuberculosis were recruited at a former TB sanatorium in India (n=290). Active TB was assessed by acid-fast bacilli sputum smear microscopy. DM (HbA1c =6.5%) and pre-DM (HbA1c <5.7% to =6.5%) were defined by concentrations of glycated hemoglobin (HbA1c) determined by high-performance liquid chromatography. Whole and segmental body composition was measured by bioelectrical impedance analysis.
Results
More than one out of every four women had DM (9.0%) or pre-DM (18.0%). About one of every three men had DM (14.4%) or pre-DM (22.1%). Among all study participants, 10.7% had active TB. A greater prevalence of men (16.0%) had active TB, compared to women (2.2%; p<0.05). Median body mass index were similar between males (18.3 kg/m2 [IQR 16.2-20.6]), and females (19.0 kg/m2 [IQR 16.0-22.4]; p>0.05). DM prevalence was significantly higher in patients with TB (22.6%), compared to patients without TB (8.8%; p<0.05).
Conclusions
Findings support the need for prospective studies to elucidate clinical and immunological consequences of this comorbidity, and incorporate screening for DM in TB management programs.
