Diabetes Mellitus is Associated with Increased Prevalence of Latent Tuberculosis Infection: Findings from the National Health and Nutrition Examination Survey, 2011-2012

Background: Type 2 diabetes mellitus is associated with threefold higher risks of active tuberculosis (TB) and an estimated 15% of the 10.4 million annual incident TB cases are attributable to diabetes. While the relationship between diabetes and TB disease is well-established, little is known about the association between diabetes and latent TB infection (LTBI). Methods: We performed a cross-sectional analysis of data from the 2011-2012 cycle of the National Health and Nutrition Examination Survey. Participants aged ³20 years were eligible for this analysis. Diabetes status was defined by glycated hemoglobin (HbA1c) as no diabetes (£5.6%), prediabetes (5.7-6.4%), and diabetes (³6.5%); participants were defined as having diabetes if they self-reported a diagnosis, regardless of HbA1c. LTBI was defined by interferon gamma release assay (IGRA) as positive, negative, or indeterminate. We used logistic regression to estimate the adjusted odds ratio and 95% confidence interval of LTBI comparing participants with diabetes and prediabetes to those with no diabetes. Results: Overall the prevalence of diabetes was 11.4% (95%CI 9.8-13.0%) and 22.1% (95%CI 20.5-23.8%) had prediabetes. The prevalence of LTBI was 5.9% (95%CI 4.9-7.0%). After adjusting for cofounding factors, the odds of prevalent LTBI was greater among adults with diabetes (aOR 1.91, 95%CI 1.16-3.16) compared to those without diabetes. Conclusion: Diabetes is associated with LTBI among adults in the US, even after adjusting for confounding factors. Given diabetes increases the risk of active TB, patients with co-prevalent diabetes and LTBI may be targeted for LTBI treatment