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Chronic Illness
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Diabetes and the risk of tuberculosis: a neglected threat to public health?

Catherine R. Stevenson

Medical Research Council Epidemiology Unit, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK

Julia A. Critchley

Institute of Health and Society, Newcastle University, William Leech Building, Newcastle upon Tyne NE2 4HH, UK, J.A.Critchley{at}ncl.ac.uk

Nita G. Forouhi

Medical Research Council Epidemiology Unit, Elsie Widdowson Laboratory, Fulbourn Road, Cambridge CB1 9NL, UK

Gojka Roglic

Department of Chronic Diseases and Health Promotion, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland

Brian G. Williams

Tuberculosis Monitoring and Evaluation, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland

Christopher Dye

Tuberculosis Monitoring and Evaluation, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland

Nigel C. Unwin

Institute of Health and Society, Newcastle University, William Leech Building, Newcastle upon Tyne NE2 4HH, UK

Objectives: Tuberculosis (TB) remains a major global public health problem. In the past, a relationship between TB and diabetes mellitus (DM) was recognized, and its importance was acknowledged through joint treatment clinics. However, this is rarely highlighted in current research or control priorities. This paper aims to evaluate the evidence for an association between these two diseases.

Methods: A Medline literature search was undertaken, supplemented by checking references and contacting experts. We critically appraised studies that quantified the association between TB and DM, and were published after 1995. We assessed study quality according to criteria such as sample size, method of selection of cases and controls, losses to follow-up, quality and method of control of confounding, and summarized the results narratively and in tabular form.

Results: All studies identified statistically significant and clinically important associations, with the increase in risk or odds of TB varying between 1.5- and 7.8-fold for those with DM. Risk was highest at younger ages. Most studies had not measured and controlled adequately for potential major confounders.

Discussion: There is strong evidence for an association between TB and DM, which has potential public health implications. Further well-designed studies are needed to assess the magnitude precisely.

Key Words: Association • Case control • Cohort • Diabetes • Tuberculosis

Chronic Illness, Vol. 3, No. 3, 228-245 (2007)
DOI: 10.1177/1742395307081502
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