Tuberculosis risk in diabetic patients from the Shanghai Suburban Adult Cohort

OBJECTIVES: This study investigated the impact of diabetes status, including whether individuals have diabetes and the various stages of diabetes, on the incidence of tuberculosis (TB), providing insights for more precise prevention and control of TB. METHODS: This population-based cohort study drew on a database from the Shanghai Suburban Adult Cohort and Biobank, comprising 35,842 participants. Adult participants with no prior history of TB who visited community health service centers for health screening between April 2016 and October 2017 were enrolled. Follow-up of eligible participants was conducted for incident TB cases after their health screening date until March 7, 2025. Cases were sourced from the database of new diagnoses spanning 2016-2025. Participants without TB served as controls and were selected through propensity score matching, with each case matched to four controls by age, sex, body mass index, smoking behavior, and alcohol consumption behavior. TB risk was compared across different groups using multivariate logistic regression. RESULTS: In total, 58 participants developed TB during follow-up. The TB incidence rate was higher in participants with newly diagnosed diabetes, at 44.00 cases per 100,000 person-years, compared to 18.55 cases in the non-diabetes mellitus group (P = 0.018). The nested case-control study indicated that the newly diagnosed diabetes group had a higher incidence of TB compared to the nondiabetic group (odds ratio 2.50, P = 0.039). CONCLUSION: Newly diagnosed diabetes patients have a higher risk of TB. Enhancing diabetes management through the prompt identification of undiagnosed cases could thereby indirectly contribute to TB control.