If the methodology of the study is sound, can you just conclude by saying that being diabetic does not confer an extra risk of being predisposed to latent TB infection (in contrast to having tuberculosis)? Or does this mean that the levels of latent TB in the community is overwhelmingly large that it is almost similar to levels in diabetics?
LTBI reflects exposure to tuberculosis disease. It would be surprising if diabetics had a higher or lower exposure to tuberculosis disease. From the available research, one would expect diabetics to have a higher chance to develop active disease.
The interesting question is: Will those diabetics exposed to TB have a higher chance of developing active disease than non-diabetics? I think you have the potential for a fascinating longitudinal study!
Thanks Paul. Yes, it would be an interesting longitudinal study. That was something that I had in mind before I ventured into analyzing this data. Perhaps I will publish the data on LTBI in diabetics and in the community first. I am will embark on the longitudinal study later.
I agree with Nirav as well. LTBI is NOT a risk factor.But if you read CDC guidelines, LTBI is a cause for concern amongst particular risk groups which brings into question the need for primary prevention.
However, the purpose of the study was to identify if there is a need for primary prevention if the exposure is indeed high for diabetic group in relation to the community. In this case, the answer would be no.
Rabin
Hi Tsuyoshi,
I diagnosed LTBI using Mantoux test, we plan to follow up later with Quantiferon-GOLD (IGRA) in a subsequent study (since its too costly to use).
For cases of immunosuppression (CKD/probably DM/SLE/Cancer), it is well known that IGRA works better in predicting LTBI.
Rabin
As stated above, LTBI has a lot to do with exposure. It would be interesting to know the prevalence of active tuberculosis disease amongst diabetics since diabetes weakens the immune system and makes patients more susceptible to infections. I am currently analyzing data of retrospective case-control study assessing if there is any association between active tuberculosis disease and diabetes.
I'm fairly certain diabetes has already been shown to increase risk of developing active disease. If you are finding that prevalence of LTBI in diabetic population is comparable to the rest of the population, I would conclude that diabetics are no more likely to be exposed to tuberculosis disease than non-diabetics. This would make sense considering the low overlap of risk factors for both. Diabetics would be a high priority for intervention when identified due to the shown increased risk of developing disease from latent infections.
I see you mentioned your diagnosis was based upon a mantoux test. Was there any radiographic follow up to rule out disease? This would be critical even if there was a lack of reported symptoms.
Hi Shawn,
Thanks for your imput. Yes, each patients who tested positive for Mantoux were subjected to chest x-rays.
Rabin
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