title: High prevalence of diabetes and anthropometric heterogeneity among tuberculosis patients in Pakistan.
abstract: In Pakistan, the prevalence of diabetes (DM) among adults is 6.9% and expected to double by 2040. DM may facilitate transmission and halter the elimination of tuberculosis (TB). We aimed to determine the prevalence of DM among patients with TB in Pakistan, and to investigate anthropometric biochemical and haemodynamic associations between TB patients with and without DM.
  
  
  
  We conducted a cross-sectional study at Gulab Devi Chest Hospital in Lahore, Punjab. A total of 3027 newly diagnosed smear-positive TB patients ≥25 years of age were screened for DM by HbA1c regardless of previous DM history.
  
  
  
  The prevalence of screen-detected DM and known DM among the TB participants was 13.5% and 26.1%, respectively, resulting in a combined DM prevalence of 39.6%. Most participants were male (64.4%). Using bivariate analyses, participants with DM were significantly older (49.8 vs. 40.6 years) with higher haemoglobin (men, 12.1 vs. 11.8 g/dl, women 11.5 vs. 10.7 g/dl), body mass index (21.0 vs. 17.6 kg/m2) and waist-hip ratio (men, 0.87 vs. 0.81, women, 0.87 vs. 0.79) (all P < 0.05) than participants without DM. Stratifying by screen-detected and known DM, these differences remained significant when using multivariate analysis.
  
  
  
  We report a high prevalence of DM among patients with TB who may be anthropometrically and biochemically distinct from TB patients without DM, and this heterogeneity further transcends the different DM groups.
authors.affiliation: Section of Global Health, Department of Public Health, University of Copenhagen, Denmark.
authors.forename: Huma
authors.initials: H
authors.lastname: Aftab
authors.affiliation: Gulab Devi Chest Hospital, Lahore, Pakistan.
authors.forename: Atiqa
authors.initials: A
authors.lastname: Ambreen
authors.affiliation: Gulab Devi Chest Hospital, Lahore, Pakistan.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Jamil
authors.affiliation: Laboratory of Molecular Medicine, Rigshospitalet, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Garred
authors.affiliation: Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark.
authors.forename: Jørgen H
authors.initials: JH
authors.lastname: Petersen
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark.
authors.forename: Susanne D
authors.initials: SD
authors.lastname: Nielsen
authors.affiliation: Section of Global Health, Department of Public Health, University of Copenhagen, Denmark.
authors.forename: Ib C
authors.initials: IC
authors.lastname: Bygbjerg
authors.affiliation: Section of Global Health, Department of Public Health, University of Copenhagen, Denmark.
authors.forename: Dirk L
authors.initials: DL
authors.lastname: Christensen
mesh_terms: D000328:Adult; D000367:Age Factors; D000886:Anthropometry; D001786:Blood Glucose / Q000378:metabolism*; D015992:Body Mass Index; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006454:Hemoglobins / Q000378:metabolism; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010154:Pakistan / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D014397:Tuberculosis, Pulmonary / Q000097:blood*; D049629:Waist-Hip Ratio
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D006454:Hemoglobins
keywords: Cribado; Diabetes; Tuberculosis; anthropometric heterogeneity; diabetes; diabète; dépistage; heterogeneidad antropométrica; hétérogénéité anthropométrique; screening; tuberculose