Global, regional, and national prevalence of diabetes mellitus in patients with pulmonary tuberculosis: a systematic review and meta-analysis

Abstract Background. The concept that people with pulmonary tuberculosis are at risk of developing diabetes mellitus has been raised. However, the prevalence of diabetes mellitus in patients with pulmonary tuberculosis have not been well established. We aim to estimate the global, regional, and national prevalence of diabetes mellitus in population with pulmonary tuberculosis. Methods. In this systematic review and meta-analysis, we assessed observational studies of diabetes mellitus in people with pulmonary tuberculosis, using PubMed and Embase electronic bibliographic databases in English language, to identify articles published until August 31, 2018. We included original research studies published in a peer-reviewed journal and reported the prevalence of diabetes mellitus or had enough data to compute these estimates. Studies were excluded if they did not provide primary data or were case studies and reviews. Independent extraction of articles and collected detailed information by 2 authors using predefined questionnaire, including study quality indicators. The country-specific random-effects meta-analyses for countries with two or more available studies and a fractional response regression model to predict individual studies prevalence of diabetes mellitus in patients with pulmonary tuberculosis for countries with one or no study. The study is registered with PROSPERO, registration number CRD42018101989. Results. We identified 18042 studies, and 127 were retained for data extraction across 46 countries. The global prevalence of diabetes mellitus in patients with pulmonary tuberculosis were estimated to be 12.07% (95%CI: 10.43-14.85). The prevalence of diabetes mellitus in patients with pulmonary tuberculosis was 13.38% (95%CI: 11.16-16.05) in region of Americas, 13.34% (95%CI: 12.82-14.61) in European region, 12.68% (95%CI: 9.15-16.37) in South-East Asia, 12.56% (95%CI: 11.79-22.70) in Western Pacific region, 10.95% (95%CI: 9.04-17.83) in Eastern Mediterranean region and 7.54% (95%CI: 6.51-8.77)in African region. The country with the highest estimated prevalence of pulmonary tuberculosis combined diabetes mellitus were Mauritius (39.65%, 95%CI: 4.22-90.74). Conclusion. Our findings suggest that pulmonary tuberculosis combined diabetes mellitus is still prevalent. As such, diabetes mellitus deserves more attention from PTB health-care providers, researchers, policy makers, and stakeholders for improved detection, overall proper management, and efficient control of diabetes mellitus in people with pulmonary tuberculosis.