The association between diabetes status and latent-TB IGRA levels from a cross-sectional study in eastern China

Cheng Chen; Xinsong Hu; Yan Shao; Honghuan Song; Guoli Li; Wei Lu; Leonardo Martinez; Jianfang Xu; Limei Zhu

doi:10.3389/fcimb.2022.1057298

The association between diabetes status and latent-TB IGRA levels from a cross-sectional study in eastern China

Front Cell Infect Microbiol. 2023 Jan 16:12:1057298. doi: 10.3389/fcimb.2022.1057298. eCollection 2022.

Authors

Cheng Chen¹, Xinsong Hu², Yan Shao¹, Honghuan Song¹, Guoli Li¹, Wei Lu¹, Leonardo Martinez³, Jianfang Xu⁴, Limei Zhu¹

Affiliations

¹ Department of Chronic Communicable Disease, Center for Disease Control and Prevention of Jiangsu Province, Nanjing, China.
² Department of Epidemiology and Statistics, School of Public Health, Nanjing Medical University, Nanjing, China.
³ Department of Epidemiology, School of Public Health, Boston University, Boston, MA, United States.
⁴ Department of Infectious Disease Control, Center for Disease Control and Prevention of Danyang County, Zhenjiang, China.

Abstract

Background: There is a debate regarding the sensitivity of the QuantiFERON-TB Gold In-Tube (QFT) among people with diabetes, and prior studies have shown heterogeneous results. We evaluated whether the QFT TB antigen was modified among persons with differing diabetes status and other related risk factors.

Methods: A cross-sectional study of 5,302 people was conducted to screen latent tuberculosis infection (LTBI) in eastern China. The QFT assay was performed as an indicator of LTBI. Fasting plasma glucose (FPG) was collected from each participant; the definition of diabetes followed the guidelines from the American Diabetes Association. Participants were classified into normoglycemia, prediabetes, undiagnosed diabetes, and previously diagnosed diabetes to evaluate the relationship between the QFT TB antigen and distinct diabetes status.

Results: TB antigen values from the QFT were statistically different among participants with differing diabetes status (P = 0.008). Persons with undiagnosed diabetes had a higher TB antigen value (0.96 ± 0.20) than persons with normoglycemia (0.50 ± 0.02, P < 0.05). However, the TB antigen values demonstrated no significant difference among the four different diabetic groups when stratified by the standard cutoff for the QFT (P = 0.492 for the positive group and P = 0.368 for the negative group). In a linear regression model, we found that FPG, age, and smoking were positively associated with the QFT TB antigen value (P = 0.017, P < 0.001, and P < 0.001).

Conclusions: Diabetes status had little influence on the level of QFT TB antigen response among IGRA-positive persons. However, FPG, old age, and smoking were important risk factors for increasing levels of QFT TB antigen.

Keywords: cross-sectional study; diabetes; interferon gamma; latent tuberculosis infection; tuberculosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
Diabetes Mellitus* / diagnosis
Humans
Interferon-gamma Release Tests / methods
Latent Tuberculosis* / diagnosis
Risk Factors
Tuberculin Test / methods

Grants and funding

This work was supported by the Jiangsu Commission of Health (grant number M2020040 and ZDA2020022) and Kunshan Scientific Project (grant number KSF202145). The funder had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.