TY - JOUR
T1 - Diabetes mellitus and tuberculosis, a systematic review and meta-analysis with sensitivity analysis for studies comparable for confounders
AU - Foe-Essomba, Joseph Rodrigue
AU - Kenmoe, Sebastien
AU - Tchatchouang, Serges
AU - Ebogo-Belobo, Jean Thierry
AU - Mbaga, Donatien Serge
AU - Kengne-Ndé, Cyprien
AU - Mahamat, Gadji
AU - Kame-Ngasse, Ginette Irma
AU - Noura, Efietngab Atembeh
AU - Mikangue, Chris Andre Mbongue
AU - Feudjio, Alfloditte Flore
AU - Taya-Fokou, Jean Bosco
AU - Touangnou-Chamda, Sabine Aimee
AU - Nayang-Mundo, Rachel Audrey
AU - Nyebe, Inès
AU - Magoudjou-Pekam, Jeannette Nina
AU - Yéngué, Jacqueline Félicité
AU - Djukouo, Larissa Gertrude
AU - Emoh, Cynthia Paola Demeni
AU - Tazokong, Hervé Raoul
AU - Bowo-Ngandji, Arnol
AU - Lontchi-Yimagou, Eric
AU - Kaiyven, Afi Leslie
AU - Donfack, Valerie Flore Donkeng
AU - Njouom, Richard
AU - Mbanya, Jean Claude
AU - Mbacham, Wilfred Fon
AU - Eyangoh, Sara
N1 - Funding Information:
The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This project is part of the EDCTP2 programme supported by the European Union under grant agreement TMA2019PF-2705.
Publisher Copyright:
© 2021 Foe-Essomba et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2021/12
Y1 - 2021/12
N2 - Introduction Meta-analyses conducted so far on the association between diabetes mellitus (DM) and the tuberculosis (TB) development risk did not sufficiently take confounders into account in their estimates. The objective of this systematic review was to determine whether DM is associated with an increased risk of developing TB with a sensitivity analyses incorporating a wider range of confounders including age, gender, alcohol consumption, smoke exposure, and other comorbidities. Methods Pubmed, Embase, Web of Science and Global Index Medicus were queried from inception until October 2020. Without any restriction to time of study, geographical location, and DM and TB diagnosis approaches, all observational studies that presented data for associations between DM and TB were included. Studies with no abstract or complete text, duplicates, and studies with wrong designs (review, case report, case series, comment on an article, and editorial) or populations were excluded. The odds ratios (OR) and their 95% confidence intervals were estimated by a random-effect model. Results The electronic and manual searches yielded 12,796 articles of which 47 were used in our study (23 case control, 14 cross-sectional and 10 cohort studies) involving 503,760 cases (DM or TB patients) and 3,596,845 controls. The size of the combined effect of TB risk in the presence of DM was OR = 2.3, 95% CI = [2.0–2.7], I2 = 94.2%. This statistically significant association was maintained in cohort (OR = 2.0, CI 95% = [1.5–2.4], I2 = 94.3%), case control (OR = 2.4, CI 95% = [2.0–2.9], I2 = 93.0%) and cross-sectional studies (OR = 2.5, CI 95% = [1.8–3.5], I2 = 95.2%). The association between DM and TB was also maintained in the sensitivity analysis including only studies with similar proportions of confounders between cases and controls. The substantial heterogeneity observed was mainly explained by the differences between geographic regions. Conclusions DM is associated with an increased risk of developing latent and active TB. To further explore the role of DM in the development of TB, more investigations of the biological mechanisms by which DM increases the risk of TB are needed.
AB - Introduction Meta-analyses conducted so far on the association between diabetes mellitus (DM) and the tuberculosis (TB) development risk did not sufficiently take confounders into account in their estimates. The objective of this systematic review was to determine whether DM is associated with an increased risk of developing TB with a sensitivity analyses incorporating a wider range of confounders including age, gender, alcohol consumption, smoke exposure, and other comorbidities. Methods Pubmed, Embase, Web of Science and Global Index Medicus were queried from inception until October 2020. Without any restriction to time of study, geographical location, and DM and TB diagnosis approaches, all observational studies that presented data for associations between DM and TB were included. Studies with no abstract or complete text, duplicates, and studies with wrong designs (review, case report, case series, comment on an article, and editorial) or populations were excluded. The odds ratios (OR) and their 95% confidence intervals were estimated by a random-effect model. Results The electronic and manual searches yielded 12,796 articles of which 47 were used in our study (23 case control, 14 cross-sectional and 10 cohort studies) involving 503,760 cases (DM or TB patients) and 3,596,845 controls. The size of the combined effect of TB risk in the presence of DM was OR = 2.3, 95% CI = [2.0–2.7], I2 = 94.2%. This statistically significant association was maintained in cohort (OR = 2.0, CI 95% = [1.5–2.4], I2 = 94.3%), case control (OR = 2.4, CI 95% = [2.0–2.9], I2 = 93.0%) and cross-sectional studies (OR = 2.5, CI 95% = [1.8–3.5], I2 = 95.2%). The association between DM and TB was also maintained in the sensitivity analysis including only studies with similar proportions of confounders between cases and controls. The substantial heterogeneity observed was mainly explained by the differences between geographic regions. Conclusions DM is associated with an increased risk of developing latent and active TB. To further explore the role of DM in the development of TB, more investigations of the biological mechanisms by which DM increases the risk of TB are needed.
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U2 - 10.1371/journal.pone.0261246
DO - 10.1371/journal.pone.0261246
M3 - Review article
C2 - 34890419
AN - SCOPUS:85121102966
SN - 1932-6203
VL - 16
JO - PLoS One
JF - PLoS One
IS - 12 December 2021
M1 - e0261246
ER -
