title: Diabetes is a risk factor for pulmonary tuberculosis: a case-control study from Mwanza, Tanzania.
abstract: BACKGROUND
  Diabetes and TB are associated, and diabetes is increasingly common in low-income countries where tuberculosis (TB) is highly endemic. However, the role of diabetes for TB has not been assessed in populations where HIV is prevalent.
  
  
  METHODS
  A case-control study was conducted in an urban population in Tanzania among culture-confirmed pulmonary TB patients and non-TB neighbourhood controls. Participants were tested for diabetes according to WHO guidelines and serum concentrations of acute phase reactants were measured. The association between diabetes and TB, and the role of HIV as an effect modifier, were examined using logistic regression. Since blood glucose levels increase during the acute phase response, we adjusted for elevated serum acute phase reactants.
  
  
  RESULTS
  Among 803 cases and 350 controls the mean (SD) age was 34.8 (11.9) and 33.8 (12.0) years, and the prevalence of diabetes was 16.7% (95% CI: 14.2; 19.4) and 9.4% (6.6; 13.0), respectively. Diabetes was associated with TB (OR 2.2, 95% CI: 1.5; 3.4, p<0.001). However, the association depended on HIV status (interaction, p = 0.01) due to a stronger association among HIV uninfected (OR 4.2, 95% CI: 1.5; 11.6, p = 0.01) compared to HIV infected (OR 0.1, 95% CI: 0.01; 1.8, p = 0.13) after adjusting for age, sex, demographic factors and elevated serum acute phase reactants.
  
  
  CONCLUSIONS
  Diabetes is a risk factor for TB in HIV uninfected, whereas the association in HIV infected patients needs further study. The increasing diabetes prevalence may be a threat to TB control.
authors.affiliation: Department of Human Nutrition, University of Copenhagen, Frederiksberg, Denmark. dfa@life.ku.dk
authors.forename: Daniel
authors.initials: D
authors.lastname: Faurholt-Jepsen
authors.forename: Nyagosya
authors.initials: N
authors.lastname: Range
authors.forename: George
authors.initials: G
authors.lastname: Praygod
authors.forename: Kidola
authors.initials: K
authors.lastname: Jeremiah
authors.forename: Maria
authors.initials: M
authors.lastname: Faurholt-Jepsen
authors.forename: Martine Grosos
authors.initials: MG
authors.lastname: Aabye
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.forename: Dirk Lund
authors.initials: DL
authors.lastname: Christensen
authors.forename: Christian Bressen
authors.initials: CB
authors.lastname: Pipper
authors.forename: Henrik
authors.initials: H
authors.lastname: Krarup
authors.forename: Daniel Rinse
authors.initials: DR
authors.lastname: Witte
authors.forename: Aase Bengaard
authors.initials: AB
authors.lastname: Andersen
authors.forename: Henrik
authors.initials: H
authors.lastname: Friis
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000453:epidemiology* / Q000821:virology; D005260:Female; D015497:HIV-1 / Q000472:pathogenicity; D015498:HIV-2 / Q000472:pathogenicity; D006801:Humans; D008297:Male; D012307:Risk Factors; D013636:Tanzania / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology* / Q000209:etiology* / Q000821:virology