The diabetes-tuberculosis co-epidemic: the role of international migration

SETTING: A tuberculosis (TB) referral centre in Rome, Italy. OBJECTIVE : To identify demographic and epidemiological characteristics associated with diabetes mellitus (DM) among patients with TB and to compare the clinical presentation of TB and TB-DM in the light of the growing worldwide burden of DM. DESIGN: We performed a retrospective study of TB cases diagnosed from 2007 to 2012. RESULT S : Among 971 TB patients, 723 were foreignborn and 63 (6.5%) had DM. DM prevalence was 12.7% (8/63) among those born in countries with DM prevalence 78%, 4.7% (31/660) among patients from countries with DM prevalence ,8% and 9.7% among Italian patients (24/248). In multivariable analysis, DM was independently associated with older age, and with being born in countries other than Italy, compared to Italians; this latter association was stronger in older patients. DM patients were also significantly more likely to be male and less likely to test positive for the human immunodeficiency virus. The presence of cavities was significantly associated with DM. CONCLUS IONS : As individuals born in high TB incidence and high DM prevalence countries emerge as a vulnerable population, greater attention to bidirectional low-cost screening in people from these countries is needed.