Burden and Characteristics of the Comorbidity Tuberculosis-Diabetes in Europe: TBnet Prevalence Survey and Case-Control Study

Monica Sane Schepisi, Assunta Navarra, M Nieves Altet Gomez, Andrii Dudnyk, Anne Margarita Dyrhol-Riise, Jaime Esteban, Pier Francesco Giorgetti, Gina Gualano, Lorenzo Guglielmetti, Jan Heyckendorf, Anna Kaluzhenina, Berit Lange, Christoph Lange, Katerina Manika, Jalal Miah, Zorica Nanovic, Emanuele Pontali, Monica Rios Prego, Ivan Solovic, Simon TiberiFabrizio Palmieri, Enrico Girardi

Research output: Contribution to journalArticle

Abstract

Background: The growing burden of diabetes mellitus (DM) is posing a threat to global tuberculosis (TB) control. DM triples the risk of developing TB, modifies the presenting features of pulmonary TB, and worsens TB treatment outcomes. We aimed to analyze the prevalence of DM among TB patients and to describe the characteristics and clinical presentation of TB-DM patients in Europe.

Methods: We performed a cross-sectional survey on the prevalence of DM among consecutively diagnosed adult TB patients in 11 European TB referral centers located in France, Germany, Greece, Italy, Russia, Slovakia, Spain, and the United Kingdom over the period 2007-2015. We also selected DM-TB cases and TB only controls with a 1:3 ratio to perform a case-control analysis, including patients selected from the countries mentioned above plus Norway and Ukraine.

Results: Among 3143 TB enrolled patients, DM prevalence overall was 10.7% and ranged from 4.4% in Greece to 28.5% in the United Kingdom. Patients' median ages ranged from 36 to 49 years, and all centers had >60% males; the proportion of foreign-born patients varied widely across sites. In the case-control study, DM was independently associated with older age and, among older patients, with being foreign-born. Among patients with pulmonary involvement, cavities on chest imaging were more frequently observed among those with DM.

Conclusions: Diabetes mellitus represents a challenge for TB control in Europe, especially in foreign-born and in elderly patients. Specific screening strategies should be evaluated.

Original languageEnglish
Pages (from-to)ofy337
JournalOpen Forum Infectious Diseases
Volume6
Issue number1
DOIs
Publication statusE-pub ahead of print - Dec 19 2018

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Case-Control Studies
Comorbidity
Tuberculosis
Diabetes Mellitus
Greece
Surveys and Questionnaires
Ukraine
Slovakia
Russia
Norway
Pulmonary Tuberculosis
Spain
Italy
France
Germany
Thorax
Referral and Consultation
Cross-Sectional Studies
Lung

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Burden and Characteristics of the Comorbidity Tuberculosis-Diabetes in Europe : TBnet Prevalence Survey and Case-Control Study. / Sane Schepisi, Monica; Navarra, Assunta; Altet Gomez, M Nieves; Dudnyk, Andrii; Dyrhol-Riise, Anne Margarita; Esteban, Jaime; Giorgetti, Pier Francesco; Gualano, Gina; Guglielmetti, Lorenzo; Heyckendorf, Jan; Kaluzhenina, Anna; Lange, Berit; Lange, Christoph; Manika, Katerina; Miah, Jalal; Nanovic, Zorica; Pontali, Emanuele; Prego, Monica Rios; Solovic, Ivan; Tiberi, Simon; Palmieri, Fabrizio; Girardi, Enrico.

In: Open Forum Infectious Diseases, Vol. 6, No. 1, 19.12.2018, p. ofy337.

Research output: Contribution to journalArticle

Sane Schepisi, M, Navarra, A, Altet Gomez, MN, Dudnyk, A, Dyrhol-Riise, AM, Esteban, J, Giorgetti, PF, Gualano, G, Guglielmetti, L, Heyckendorf, J, Kaluzhenina, A, Lange, B, Lange, C, Manika, K, Miah, J, Nanovic, Z, Pontali, E, Prego, MR, Solovic, I, Tiberi, S, Palmieri, F & Girardi, E 2018, 'Burden and Characteristics of the Comorbidity Tuberculosis-Diabetes in Europe: TBnet Prevalence Survey and Case-Control Study', Open Forum Infectious Diseases, vol. 6, no. 1, pp. ofy337. https://doi.org/10.1093/ofid/ofy337
Sane Schepisi, Monica ; Navarra, Assunta ; Altet Gomez, M Nieves ; Dudnyk, Andrii ; Dyrhol-Riise, Anne Margarita ; Esteban, Jaime ; Giorgetti, Pier Francesco ; Gualano, Gina ; Guglielmetti, Lorenzo ; Heyckendorf, Jan ; Kaluzhenina, Anna ; Lange, Berit ; Lange, Christoph ; Manika, Katerina ; Miah, Jalal ; Nanovic, Zorica ; Pontali, Emanuele ; Prego, Monica Rios ; Solovic, Ivan ; Tiberi, Simon ; Palmieri, Fabrizio ; Girardi, Enrico. / Burden and Characteristics of the Comorbidity Tuberculosis-Diabetes in Europe : TBnet Prevalence Survey and Case-Control Study. In: Open Forum Infectious Diseases. 2018 ; Vol. 6, No. 1. pp. ofy337.
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abstract = "Background: The growing burden of diabetes mellitus (DM) is posing a threat to global tuberculosis (TB) control. DM triples the risk of developing TB, modifies the presenting features of pulmonary TB, and worsens TB treatment outcomes. We aimed to analyze the prevalence of DM among TB patients and to describe the characteristics and clinical presentation of TB-DM patients in Europe.Methods: We performed a cross-sectional survey on the prevalence of DM among consecutively diagnosed adult TB patients in 11 European TB referral centers located in France, Germany, Greece, Italy, Russia, Slovakia, Spain, and the United Kingdom over the period 2007-2015. We also selected DM-TB cases and TB only controls with a 1:3 ratio to perform a case-control analysis, including patients selected from the countries mentioned above plus Norway and Ukraine.Results: Among 3143 TB enrolled patients, DM prevalence overall was 10.7{\%} and ranged from 4.4{\%} in Greece to 28.5{\%} in the United Kingdom. Patients' median ages ranged from 36 to 49 years, and all centers had >60{\%} males; the proportion of foreign-born patients varied widely across sites. In the case-control study, DM was independently associated with older age and, among older patients, with being foreign-born. Among patients with pulmonary involvement, cavities on chest imaging were more frequently observed among those with DM.Conclusions: Diabetes mellitus represents a challenge for TB control in Europe, especially in foreign-born and in elderly patients. Specific screening strategies should be evaluated.",
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TY - JOUR

T1 - Burden and Characteristics of the Comorbidity Tuberculosis-Diabetes in Europe

T2 - TBnet Prevalence Survey and Case-Control Study

AU - Sane Schepisi, Monica

AU - Navarra, Assunta

AU - Altet Gomez, M Nieves

AU - Dudnyk, Andrii

AU - Dyrhol-Riise, Anne Margarita

AU - Esteban, Jaime

AU - Giorgetti, Pier Francesco

AU - Gualano, Gina

AU - Guglielmetti, Lorenzo

AU - Heyckendorf, Jan

AU - Kaluzhenina, Anna

AU - Lange, Berit

AU - Lange, Christoph

AU - Manika, Katerina

AU - Miah, Jalal

AU - Nanovic, Zorica

AU - Pontali, Emanuele

AU - Prego, Monica Rios

AU - Solovic, Ivan

AU - Tiberi, Simon

AU - Palmieri, Fabrizio

AU - Girardi, Enrico

PY - 2018/12/19

Y1 - 2018/12/19

N2 - Background: The growing burden of diabetes mellitus (DM) is posing a threat to global tuberculosis (TB) control. DM triples the risk of developing TB, modifies the presenting features of pulmonary TB, and worsens TB treatment outcomes. We aimed to analyze the prevalence of DM among TB patients and to describe the characteristics and clinical presentation of TB-DM patients in Europe.Methods: We performed a cross-sectional survey on the prevalence of DM among consecutively diagnosed adult TB patients in 11 European TB referral centers located in France, Germany, Greece, Italy, Russia, Slovakia, Spain, and the United Kingdom over the period 2007-2015. We also selected DM-TB cases and TB only controls with a 1:3 ratio to perform a case-control analysis, including patients selected from the countries mentioned above plus Norway and Ukraine.Results: Among 3143 TB enrolled patients, DM prevalence overall was 10.7% and ranged from 4.4% in Greece to 28.5% in the United Kingdom. Patients' median ages ranged from 36 to 49 years, and all centers had >60% males; the proportion of foreign-born patients varied widely across sites. In the case-control study, DM was independently associated with older age and, among older patients, with being foreign-born. Among patients with pulmonary involvement, cavities on chest imaging were more frequently observed among those with DM.Conclusions: Diabetes mellitus represents a challenge for TB control in Europe, especially in foreign-born and in elderly patients. Specific screening strategies should be evaluated.

AB - Background: The growing burden of diabetes mellitus (DM) is posing a threat to global tuberculosis (TB) control. DM triples the risk of developing TB, modifies the presenting features of pulmonary TB, and worsens TB treatment outcomes. We aimed to analyze the prevalence of DM among TB patients and to describe the characteristics and clinical presentation of TB-DM patients in Europe.Methods: We performed a cross-sectional survey on the prevalence of DM among consecutively diagnosed adult TB patients in 11 European TB referral centers located in France, Germany, Greece, Italy, Russia, Slovakia, Spain, and the United Kingdom over the period 2007-2015. We also selected DM-TB cases and TB only controls with a 1:3 ratio to perform a case-control analysis, including patients selected from the countries mentioned above plus Norway and Ukraine.Results: Among 3143 TB enrolled patients, DM prevalence overall was 10.7% and ranged from 4.4% in Greece to 28.5% in the United Kingdom. Patients' median ages ranged from 36 to 49 years, and all centers had >60% males; the proportion of foreign-born patients varied widely across sites. In the case-control study, DM was independently associated with older age and, among older patients, with being foreign-born. Among patients with pulmonary involvement, cavities on chest imaging were more frequently observed among those with DM.Conclusions: Diabetes mellitus represents a challenge for TB control in Europe, especially in foreign-born and in elderly patients. Specific screening strategies should be evaluated.

U2 - 10.1093/ofid/ofy337

DO - 10.1093/ofid/ofy337

M3 - Article

C2 - 30697572

VL - 6

SP - ofy337

JO - Open Forum Infectious Diseases

JF - Open Forum Infectious Diseases

SN - 2328-8957

IS - 1

ER -