title: Increased risk of latent tuberculous infection among persons with pre-diabetes and diabetes mellitus.
abstract: METHODS
  Although diabetes mellitus (DM) is an established risk factor for active tuberculosis (TB) disease, little is known about the association between pre-DM, DM, and latent tuberculous infection (LTBI).
  
  
  OBJECTIVE
  To estimate the association between DM and LTBI.
  
  
  METHODS
  We conducted a cross-sectional study among recently arrived refugees seen at a health clinic in Atlanta, GA, USA, between 2013 and 2014. Patients were screened for DM using glycosylated-hemoglobin (HbA1c), and for LTBI using the QuantiFERON(®)-TB (QFT) test. HbA1c and QFT results, demographic information, and medical history were abstracted from patient charts.
  
  
  RESULTS
  Among 702 included patients, 681 (97.0%) had HbA1c and QFT results. Overall, 54 (7.8%) patients had DM and 235 (33.8%) had pre-DM. LTBI was prevalent in 31.3% of the refugees. LTBI prevalence was significantly higher (P < 0.01) among patients with DM (43.4%) and pre-DM (39.1%) than in those without DM (25.9%). Refugees with DM (adjusted OR [aOR] 2.3, 95%CI 1.2-4.5) and pre-DM (aOR 1.7, 95%CI 1.1-2.4) were more likely to have LTBI than those without DM.
  
  
  CONCLUSIONS
  Refugees with DM or pre-DM from high TB burden countries were more likely to have LTBI than those without DM. Dysglycemia may impair the immune defenses involved in preventing Mycobacterium tuberculosis infection.
authors.affiliation: School of Medicine, Emory University, Atlanta, Georgia, USA.
authors.forename: R L
authors.initials: RL
authors.lastname: Hensel
authors.affiliation: School of Medicine, Emory University, Atlanta, Georgia, USA; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: R R
authors.initials: RR
authors.lastname: Kempker
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: J
authors.initials: J
authors.lastname: Tapia
authors.affiliation: DeKalb County Board of Health, Decatur, Georgia, USA.
authors.forename: A
authors.initials: A
authors.lastname: Oladele
authors.affiliation: School of Medicine, Emory University, Atlanta, Georgia, USA; Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA; Departments of Epidemiology and Global Health, Emory Rollins School of Public Health, Atlanta, Georgia, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Blumberg
authors.affiliation: Departments of Epidemiology and Global Health, Emory Rollins School of Public Health, Atlanta, Georgia, USA; Division of Epidemiology and Biostatistics, Georgia State University, School of Public Health, Atlanta, Georgia, USA.
authors.forename: M J
authors.initials: MJ
authors.lastname: Magee
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D055985:Latent Tuberculosis / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State; D012036:Refugees / Q000706:statistics & numerical data; D012307:Risk Factors; D012959:Socioeconomic Factors; D014374:Tuberculin Test
chemical_list: D006442:Glycated Hemoglobin