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Vol 24, No. 05, May 2020For e-subscribers (PDF)
Study Finds Underweight Patients with Diabetes have Increased Risk of Tuberculosis
New study nested in the long-running Singapore Chinese Health Study found that those who suffer from diabetes and are underweight have a much higher risk of active tuberculosis (TB).

It has been established that diabetes is a risk factor for active TB disease. Epidemiologic studies have also shown that individuals with low body mass index (BMI), especially those who fall within the lean or underweight range have an increased risk of active TB compared to those with higher BMI.

In western populations, increased BMI is a risk factor for diabetes with most patients with diabetes having a high BMI. By contrast, in Asian populations, a large proportion of patients with diabetes are lean or even underweight. This proves the public health importance to study the joint effect of diabetes and BMI in modulating the risk of TB in Asian populations.

The research team was led by Professor Koh Woon Puay from the Duke-NUS Medical School and the National University of Singapore’s Saw Swee Hock School of Public Health. Using data from the Singapore Chinese Health study, a population-based study, they were able to examine the combined association of diabetes and BMI with risk of active TB disease.

Professor Koh, the Principal Investigator of the Singapore Chinese Health Study, explained, “The key finding in this study is that diabetes and low BMI are independent risk factors for active TB disease. Hence, patients with diabetes and who are also lean or underweight have a substantially increased risk from the effects of both factors.”

Dr Cynthia Chee, a co-author of the study, commented, “Singapore’s TB incidence rate of 35 to 40 per 100,000 population is 5–10 times that of the US, Australia and the UK. Diabetes is a major problem in Singapore, affecting one in nine persons aged 18 to 69. In order to bring down our TB rate, it is important for all physicians to have a heightened awareness of the link between diabetes and TB, so as to facilitate the early diagnosis of active TB in this important risk group.”

“The National Tuberculosis Programme – also known as the Singapore Tuberculosis Elimination Programme, or STEP – welcomes the publication of this landmark study and is proud to have played a part,” said Adjunct Associate Professor Jeffery Cutter, Acting Director, National Tuberculosis Programme, National Centre for Infectious Diseases.

Through the results of this study, Professor Anthony Harries, a renowned researcher in TB from the International Union Against Tuberculosis and Lung Disease called for physicians in diabetes clinics to practice targeted screening focussing on underweight individuals. Also, for future research to study the value of targeted TB preventive therapy among underweight diabetic patients.

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