title: Diabetes Mellitus and Latent Tuberculosis Infection: A Systematic Review and Metaanalysis.
abstract: Despite the well-documented association between diabetes and active tuberculosis, evidence of the association between diabetes and latent tuberculosis infection (LTBI) remains limited and inconsistent.
  
  
  
  We included observational studies that applied either the tuberculin skin test or the interferon gamma release assay for diagnosis of LTBI and that provided adjusted effect estimate for the association between diabetes and LTBI. We searched PubMed and EMBASE through 31 January 2016. The risk of bias of included studies was assessed using a quality assessment tool modified from the Newcastle-Ottawa scale.
  
  
  
  Thirteen studies (1 cohort study and 12 cross-sectional studies) were included, involving 38263 participants. The cohort study revealed an increased but nonsignificant risk of LTBI among diabetics (risk ratio, 4.40; 95% confidence interval [CI], 0.50-38.55). For the cross-sectional studies, the pooled odds ratio from the random-effects model was 1.18 (95% CI, 1.06-1.30), with a small statistical heterogeneity across studies (I2, 3.5%). The risk of bias assessment revealed several methodological issues, but the overall direction of biases would reduce the positive causal association between diabetes and LTBI.
  
  
  
  Diabetes was associated with a small but statistically significant risk for LTBI. Findings from this review could be used to inform future cost-effectiveness analysis on the impact of LTBI screening programs among diabetics.
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, Taiwan.|Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.
authors.forename: Meng-Rui
authors.initials: MR
authors.lastname: Lee
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.|Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan.|Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan.
authors.forename: Ya-Ping
authors.initials: YP
authors.lastname: Huang
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital Bei-Hu Branch, Taiwan.
authors.forename: Yu-Ting
authors.initials: YT
authors.lastname: Kuo
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.
authors.forename: Chen-Hao
authors.initials: CH
authors.lastname: Luo
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.
authors.forename: Yun-Ju
authors.initials: YJ
authors.lastname: Shih
authors.affiliation: Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Chin-Chung
authors.initials: CC
authors.lastname: Shu
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taiwan.
authors.forename: Jann-Yuan
authors.initials: JY
authors.lastname: Wang
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu Branch, Hsin-Chu, Taiwan.|Department of Internal Medicine, National Taiwan University Hospital, Taiwan.
authors.forename: Jen-Chung
authors.initials: JC
authors.lastname: Ko
authors.affiliation: Department of Internal Medicine, National Taiwan University Hospital, Taiwan.
authors.forename: Chong-Jen
authors.initials: CJ
authors.lastname: Yu
authors.affiliation: Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taiwan.
authors.forename: Hsien-Ho
authors.initials: HH
authors.lastname: Lin
mesh_terms: D015331:Cohort Studies; D003430:Cross-Sectional Studies; D048909:Diabetes Complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006801:Humans; D055985:Latent Tuberculosis / Q000150:complications* / Q000453:epidemiology*; D016017:Odds Ratio; D017594:Publication Bias
keywords: diabetes mellitus; latent tuberculosis infection; metaanalysis; systemic review