1. Introduction
iabetes is one of the diseases that negatively affects the quality of life [
1]. Diabetes is a metabolic disorder and has a direct relationship with Tuberculosis (TB) [
2]. Diabetics are at higher risk for various types of infections [
4,
3]. Results of a study showed that diabetes exacerbates the TB complications and affects the radiological manifestations of the disease [
5]. Pulmonary infections in diabetic patients alter host defenses. Therefore, the TB severity is directly related to the blood sugar level and the host defense [
3]. TB is one of the most important health challenges in the world [
6] and is the leading cause of death from single infectious agent [
7]. The prevalence of TB differs in different parts of world. It has been reported that 22 countries in Eastern Mediterranean as well as Pakistan, Afghanistan, Egypt, Iraq, Iran, Morocco, Somalia, Sudan, and Yemen accounted for 95% of TB cases [
11,
10,
9 ,
8]. According to available statistics in Iran, Sistan and Baluchestan (n=330, 16.94 per 100000 people) and Golestan (n=428, 22.88 per 100000 people) provinces have the highest TB cases [
12]. Golestan Province is a TB-endemic area of Iran with the highest TB prevalence [
13]. Clinical symptoms of TB are often non-specific and include fever, night sweats, weight loss, anorexia, and fatigue [
14]. Various factors such as age, thoracic radiological signs, the presence of a high number of bacilli in sputum smear of patients at the beginning of treatment, diabetes, immunosuppressive drugs, irregularities in the implementation of the treatment plan, or absence from treatment session affect the success or failure of TB treatment [
13,
14,
15,
16,
17,
18,
19,
20,
21].
There are differences between diabetic patients and general population in the manifestation of symptoms of various comorbidities, including TB, such as lower prevalence, cough, sputum, and weight loss [
22]. Among the cities of Golestan Province, Kordkuy has the highest prevalence of diabetes (8.1%) and refractory TB cases have been observed among diabetic patients in this city. The present study aims to screen pulmonary TB and determine the prevalence of TB in people with diabetes living in rural areas of Kordkuy City.
2. Materials and Methods This is a descriptive cross-sectional study, which was approved by the Research Ethics Committee of Guilan University of Medical Sciences (Code: IR.GUMS.REC.1397.219). The study population included all diabetic patients living in 19 villages of Kordkuy city. Samples were selected using a census method. The exclusion criterion was pregnancy due to not being possible to do x-ray to prevent harm to the fetus. Informed consent was obtained from all participants. Data collection was carried out using a checklist, laboratory observations, chest x-ray (except for those forbidden to radiation exposure), TB skin test, and finally collecting sputum samples from patients who were more likely to be exposed to TB. The studied variables were: Age, gender, ethnicity, smoking, use of narcotic drugs or psychotropic substances, type of diabetes, duration of diabetes, history of previous TB, history and duration of contact with TB patients, sputum smear result, lung x-ray, last fasting blood sugar level, and last HbA1C test results. The collected data were analyzed in SPSS V. 16 software.
3. Results
Results showed that 77.4% of participants (n=716) were female, 98.2% (n=923) were Iranian nationals, and 886 (95.8%) were Persian. Demographic characteristics of participants are shown in
Table 1.
![](./files/site1/images/t1.jpg)
Their mean age was 58.40 ±11.10 years with a mean diabetes duration of 8.5±39.47 years. Eight patients (0.9%) had kidney failure, none had acquired immunodeficiency disease, and 10 (1.1%) had a history of TB. We identified one case of active TB with smear-positive sputum. The patient was a 55-year-old woman, housekeeper, with Persian ethnicity, one year history of diabetes, and no history of contact with TB patients (
Table 2).
4. Discussion and Conclusion
Recent studies have reported the prevalence of pulmonary TB in diabetic people is 4-5 times more than that in normal people [
4]. Diabetes is a risk factor with indirect role in the development of TB [
17]. In a study, the incidence of TB in diabetic group was 4.7 times higher than in non-diabetic people [
21]. The current study revealed the relationship between diabetes and TB and showed that the TB prevalence was about 0.001 among diabetic patients. To better compare the prevalence of the disease in the same rural population and at the same time, pulmonary TB patients living in the village but had no diabetes were also examined. Study on some diabetic patients showed that there were confounding factors that made it more difficult to diagnose the disease. For example, addiction of the TB patient and his/her spouse led to the absence of some symptoms of TB in them. There have been contradictory results about the role of TB in the development of diabetes [
17,
24]. Basoglu showed no significant difference between the two groups [
22].
TB prevalence among diabetic people in Kordkuy city is 60 times higher. Both TB and diabetes are health risk factors. It is also recommended to conduct large-scale clinical studies in Iran to investigate other risk factors and TB symptoms in diabetic patients.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Research Ethics Committee of Guilan University of Medical Sciences (Ethics Code: IR.GUMSREC.1397.219).
Funding
This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.
Authors' contributions
All authors equally contributed to preparing this article.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgments
The authors would like to thank all the officials of the centers, the volunteers, and all those who participated in the study and the efforts of Ms. Zeinab Khalilnejad.
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