Association of Pulmonary Tuberculosis and Diabetes in Mexico: Analysis of the National Tuberculosis Registry 2000–2012

<div><p>Background</p><p>Tuberculosis (TB) remains a public health problem in Mexico while the incidence of diabetes mellitus type 2 (DM) has increased rapidly in recent years.</p><p>Objective</p><p>To describe the trends of incidence rates of pulmonary TB associated with DM and not associated with DM and to compare the results of treatment outcomes in patients with and without DM.</p><p>Materials and Methods</p><p>We analysed the National Tuberculosis Registry from 2000 to 2012 including patients with pulmonary TB among individuals older than 20 years of age. The association between DM and treatment failure was analysed using logistic regression, accounting for clustering due to regional distribution.</p><p>Results</p><p>In Mexico from 2000 to 2012, the incidence rates of pulmonary TB associated to DM increased by 82.64%, (p <0.001) in contrast to rates of pulmonary TB rate without DM, which decreased by 26.77%, (p <0.001). Patients with a prior diagnosis of DM had a greater likelihood of failing treatment (adjusted odds ratio, 1.34 (1.11–1.61) p <0.002) compared with patients who did not have DM. There was statistical evidence of interaction between DM and sex. The odds of treatment failure were increased in both sexes.</p><p>Conclusion</p><p>Our data suggest that the growing DM epidemic has an impact on the rates of pulmonary TB. In addition, patients who suffer from both diseases have a greater probability of treatment failure.</p></div

Characteristics of pulmonary TB patients according to DM diagnosis, Mexico 2000–2012.

<p>TB, Tuberculosis; DM, Diabetes mellitus; OR, Odds Ratio; CI, Confidence Interval; IQR, Interquartile range; MDR, multidrug resistance.</p><p>* Chi-square test.</p><p>** Mann–Whitney Test.</p><p>† Binomial test.</p><p>Characteristics of pulmonary TB patients according to DM diagnosis, Mexico 2000–2012.</p

Association of treatment failure with DM and other patient characteristics among patients with pulmonary TB among the subgroup of patients with antimicrobial susceptibility results, by multivariate analyses^* Mexico 2000–2012.

<p>DM, Diabetes mellitus; TB, Tuberculosis; MDR, multidrug resistant; OR, Odds Ratio; CI, Confidence Interval.</p><p>* Logistic regression analysis accounting for clustering due to regional distribution.</p><p>Association of treatment failure with DM and other patient characteristics among patients with pulmonary TB among the subgroup of patients with antimicrobial susceptibility results, by multivariate analyses^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0129312#t004fn002" target="_blank">*</a>} Mexico 2000–2012.</p

Adjusted odds ratio (OR)^* and 95% Confidence Intervals (CI) for MDR TB, Mexico 2000–2012.

<p>*Logistic regression analysis accounting for clustering due to regional distribution. All models were adjusted for sex (except in stratified by sex analysis), age, treatment for a previous TB episode, and malnutrition.</p><p>Adjusted odds ratio (OR)^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0129312#t002fn001" target="_blank">*</a>} and 95% Confidence Intervals (CI) for MDR TB, Mexico 2000–2012.</p

Trends of pulmonary TB rates and number of cases according to age groups and prior diagnosis of DM, Mexico 2000–2012.

<p>Number of pulmonary TB patients (bar) and incidence rates of pulmonary TB (line). Panel A: Pulmonary TB patients with a previous diagnosis of DM. Panel B: Pulmonary TB patients without a previous diagnosis of DM. Panel C: Total pulmonary TB patients with and without a previous diagnosis of DM. * p trend <0.001. TB; Tuberculosis; DM, Diabetes mellitus.</p