Diabetes Mellitus and Latent Tuberculosis Infection: An Updated Meta-Analysis and Systematic Review

Abstract

Abstract Background Previous studies have shown an association between diabetes mellitus (DM) and latent tuberculosis infection (LTBI), but there is limited evidence on the association between diabetes and LTBI. This study was conducted to systematically assess the association between DM and LTBI. Methods We searched Embase, Cochrane Library, and PubMed with no start date or language restrictions on July 19, 2022. Observational studies providing adjusted effect estimates of the association between DM and LTBI were included. The methodological quality of eligible studies was assessed, with pooled effects estimated using random-effects models with risk ratios (RRs), odds ratios (ORs), and their 95% confidence intervals (CIs). Results We included 22 studies involving 68,256 subjects. Three cohort studies were eligible, with an RR of 1.69 (95% CI: 0.79–3.64). Nineteen cross-sectional studies were eligible, with a pooled OR of 1.23 (95% CI: 1.06–1.43). Although not reaching statistical significance, the pooled OR of contacts and immigrants was higher than that of community residents (pooled OR: 1.51, 95% CI: 1.23–1.86 versus 1.19, 95% CI: 0.66–2.14, respectively). In addition, the pooled OR was higher in the diabetes group using HbA1c diagnosis than in the self-reported diabetes group, with pooled OR values of 1.38 (95% CI: 0.83–2.29) and 1.18 (95% CI: 1.00–1.40), respectively. Conclusion Diabetes is associated with a small but statistically significant risk of LTBI. Nonetheless, the economic benefit of screening for LTBI in people with DM may be low. In those at high risk of TB infection who underwent a rigorous diagnosis of DM, the association between DM and LTBI may be increased. Our study shows that screening for LTBI in people with diabetes who have high risk factors for TB can help prevent diabetes and TB co-infection.