title: The role of diabetes on the clinical manifestations of pulmonary tuberculosis.
abstract: OBJECTIVE
  Diabetes is associated with pulmonary tuberculosis (TB), possibly due to impaired immunity, and diabetes may exacerbate the clinical manifestations of TB. Our aim was to assess the role of diabetes in the clinical manifestations of TB.
  
  
  METHODS
  We studied 1250 patients with pulmonary TB in an urban population in a cross-sectional study in Tanzania. All participants were tested for diabetes and HIV co-infection, and TB culture intensity was assessed. Levels of white blood cells, haemoglobin, acute phase reactants, CD4 count and HIV viral load were measured, and a qualitative morbidity questionnaire was used to identify the prevalence of disease-related symptoms.
  
  
  RESULTS
  Tuberculosis patients with diabetes had a higher neutrophil count (B 0.5 × 10(9) cells/l, 95% CI 0.2; 0.9, P = 0.001) than non-diabetic TB patients. Serum C-reactive protein (B 18.8 mg/l, CI 95% 8.2; 29.4, P = 0.001) and alpha-1-acid glycoprotein (B 0.2 g/l, CI 95% 0.03; 0.3, P = 0.02) were similarly higher in patients with diabetes. Diabetes did not affect culture intensity or HIV status, but self-reported fever was three times higher among participants with diabetes than in those without diabetes (OR 2.9, CI 95% 1.5; 5.7, P = 0.002).
  
  
  CONCLUSIONS
  Diabetes is associated with small changes in the manifestations of TB, but may have little clinical significance.
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 G
authors.initials: MG
authors.lastname: Aabye
authors.forename: John
authors.initials: J
authors.lastname: Changalucha
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Christensen
authors.forename: Henrik
authors.initials: H
authors.lastname: Krarup
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Witte
authors.forename: Aase B
authors.initials: AB
authors.lastname: Andersen
authors.forename: Henrik
authors.initials: H
authors.lastname: Friis
mesh_terms: D000328:Adult; D002097:C-Reactive Protein / Q000378:metabolism; D060085:Coinfection; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D005260:Female; D015658:HIV Infections / Q000150:complications; D006679:HIV Seropositivity / Q000150:complications; D006801:Humans; D007958:Leukocyte Count; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009169:Mycobacterium tuberculosis / Q000302:isolation & purification; D009504:Neutrophils / Q000166:cytology; D009961:Orosomucoid / Q000378:metabolism; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013636:Tanzania / Q000453:epidemiology; D014397:Tuberculosis, Pulmonary / Q000503:physiopathology*; D014505:Urban Population
chemical_list: D009961:Orosomucoid; D002097:C-Reactive Protein