title: Does enhanced diabetes management reduce the risk and improve the outcome of tuberculosis?
abstract: METHODS
  The Bureau of National Health Insurance (NHI) has implemented a pay-for-performance (p4p) programme for diabetes mellitus (DM) in Taiwan.
  
  
  OBJECTIVE
  To investigate whether patients with DM enrolled in the p4p programme (DM-p4p) are less likely to develop tuberculosis (TB) and whether they have a better outcome than patients with DM not enrolled in the p4p programme (DM-non-p4p) if they do develop TB.
  
  
  METHODS
  A random sample of 79,471 DM-p4p, 100,000 DM-non-p4p and 100,000 non-diabetic patients (non-DM) was obtained from the 2008-2009 NHI database, and the patients were matched with the National TB Registry to determine whether they had developed TB by the end of 2010.
  
  
  RESULTS
  The average annual incidence of TB was respectively 259.9 (95%CI 230.2-293.4), 137.5 (95%CI 116.4-162.5) and 74.1 (95%CI 59.0-93.0) per 100,000 population among DM-non-p4p, DM-p4p and non-DM patients. The relative risk of death over treatment success was 1.79 (95%CI 1.05-3.04) among DM-non-p4p and 1.69 (95%CI 0.84-3.40) among non-DM patients, relative to DM-p4p patients.
  
  
  CONCLUSIONS
  Enhanced case management of DM reduced risk and improved outcomes of TB among patients with DM.
authors.affiliation: Taiwan Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: H-Y
authors.initials: HY
authors.lastname: Lo
authors.affiliation: Taiwan Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: S-L
authors.initials: SL
authors.lastname: Yang
authors.affiliation: Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
authors.forename: H-H
authors.initials: HH
authors.lastname: Lin
authors.affiliation: School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, and Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
authors.forename: K-J
authors.initials: KJ
authors.lastname: Bai
authors.affiliation: Department of Internal Medicine, Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan.
authors.forename: J-J
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, and Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: T-I
authors.initials: TI
authors.lastname: Lee
authors.affiliation: Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, 111 Hsin-Long Road, Section 3, Taipei, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; International Union Against Tuberculosis and Lung Disease, Paris, France. cychiang@theunion.org.
authors.forename: C-Y
authors.initials: CY
authors.lastname: Chiang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology*; D019468:Disease Management; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009313:National Health Programs; D012052:Reimbursement, Incentive; D012307:Risk Factors; D013624:Taiwan; D016896:Treatment Outcome; D014376:Tuberculosis / Q000188:drug therapy / Q000453:epidemiology / Q000517:prevention & control*