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 journalArticlepeer-review


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
Issue number1
Publication statusE-pub ahead of print - Dec 19 2018


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