Tuberculosis and Diabetes National Web-based Seminar Francis J. Curry National TB Center San Francisco, California December 1, 29 Jane Kelly, M.D. Centers for Disease Control and Prevention jkelly@cdc.gov The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. Background Diabetes increases risk for progression from latent TB infection (LTBI) to active TB disease and complicates treatment of active TB disease There are often delays in diagnosis i for both TB and diabetes The number of people with diabetes in the US and in the world is increasing th Diabetes Percent wi Number and Percentage of U.S. Population with Diagnosed Diabetes 7 2 6 Percent with Diabetes 18 16 Number with Diabetes 5 14 4 12 1 3 8 2 6 4 1 2 1958 62 66 7 74 78 82 86 9 94 98 2 6 Year CDC s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics es (Millions) Number with Diabete Tuberculosis and Diabetes - Dec. 1, 29 Jane Kelly, M.D. 1of 5
Prevalence of Diagnosed Diabetes by Age, Ethnicity, and Sex, United States, 26 http://www.cdc.gov/diabetes/statistics/prevalence_national.htm Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI 3 kg/m 2 ) 1994 2 27 No Data <14.% 14.-17.9% 18.-21.9% 22.-25.9% >26.% Diabetes 1994 2 27 No Data <4.5% 4.5-5.9% 6.-7.4% 7.5-8.9% >9.% CDC s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics Tuberculosis and Diabetes - Dec. 1, 29 Jane Kelly, M.D. 2of 5
Worldwide Diabetes Prevalence 8 7 1995 2 225 (projected) 6 5 4 3 2 1 Africa Americas Eastern Mediterranean Europe Southeast Asia Western Pacific World Health Organization; 21. BMI and DM Risk Among Asians BMI >26 for increased diabetes risk is inappropriate for Asians American Diabetes Association considers people of Asian ethnicity at increased risk at BMI >23 The Lancet, Vol 363, January 1, 24 www.thelancet.com BMI and DM Risk Among Asians (2) Two men, different ethnicity Same BMI (22.3) Different visceral fat composition Different DM risk The Lancet, Vol 363, January 1, 24 www.thelancet.com Tuberculosis and Diabetes - Dec. 1, 29 Jane Kelly, M.D. 3of 5
TB and DM: Deadly Duo Pathophysiology - diabetes, especially poorlycontrolled diabetes, causes relative immunocompromise and increases likelihood of reactivation TB Epidemiology - diabetes dramatically increasing Demographics - diabetes disproportionately affects lower socioeconomic groups and ethnic minorities that also have higher prevalence of tuberculosis Treatment considerations - hard to treat an infection in the face of poor glucose control Hidden epidemic - estimated that 1/4 of people with diabetes don t know they have it American Diabetes Association Diagnostic Criteria 1. FPG >126 mg/dl (7. mmol/l) OR 2. Symptoms of hyperglycemia and a random plasma glucose >2 mg/dl (11.1 mmol/l) OR 3. 2-h plasma glucose >2 mg/dl (11.1 mmol/l) during an OGTT using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.* *In the absence of unequivocal hyperglycemia, these criteria should be confirmed by repeat testing on a different day IHS Diabetes Standards of Care If known +TST treat, unless contraindicated Do tuberculin skin testing (TST) of all adults with diabetes within one year of diabetes diagnosis if the TST status is negative or unknown If no TST since the diagnosis of diabetes, TST status should be determined A decision to test is a decision to treat Diabetes and +TST of indeterminate age or long-standing untreated LTBI -- Treat Even if >2 years since initial positive Even if >age 35 Tuberculosis and Diabetes - Dec. 1, 29 Jane Kelly, M.D. 4of 5
TB and DM: Need to Think of Both Clinical presentation Dx of both TB and diabetes are often delayed TB may present differently in diabetes Measuring ggy glycemic control is important Cannot rely solely on history of diabetes Need to look for and treat diabetes if present Tuberculosis and Diabetes - Dec. 1, 29 Jane Kelly, M.D. 5of 5