{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T22:14:50Z","timestamp":1778278490398,"version":"3.51.4"},"reference-count":29,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T00:00:00Z","timestamp":1681171200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T00:00:00Z","timestamp":1681171200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education","award":["NRF-2020R1F1A1049539"],"award-info":[{"award-number":["NRF-2020R1F1A1049539"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Respir Res"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Many have the rising coincidence of diabetes mellitus (DM) and endemic tuberculosis (TB). We evaluated whether the severity of diabetes is associated with an increased risk of active TB infection.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>\u00a0Using a nationally representative database from the Korean National Health Insurance System, 2, 489, 718 people with type 2 DM who underwent a regular health checkup during 2009\u20132012 were followed up until the end of 2018. The diabetes severity score parameters included the number of oral hypoglycemic agents (\u2265\u20093), insulin use, diabetes duration (\u2265\u20095\u00a0years), and the presence of chronic kidney disease (CKD) or cardiovascular disease. Each of these characteristics was scored as one point, and their sum (0\u20135) was used as the diabetes severity score.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We identified 21, 231 cases of active TB during a median follow-up of 6.8\u00a0years. Each parameter of the diabetes severity score was associated with an increased risk of active TB (all P\u2009&lt;\u20090.001). Insulin use was the most significant factor related to the risk of TB, followed by CKD. The risk of TB increased progressively with increasing diabetes severity score. After adjusting for possible confounding factors, the hazard ratio (95% confidence interval) for TB were 1.23 (1.19\u20131.27) in participants with one parameter, 1.39 (1.33\u20131.44) in those with two parameters, 1.65 (1.56\u20131.73) in those with three parameters, 2.05 (1.88\u20132.23) in those with four parameters, and 2.62 (2.10\u20133.27) in those with five parameters compared with participants with no parameters.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Diabetes severity was strongly associated in a dose-dependent manner with the occurrence of active TB. People with a higher diabetes severity score may be a targeted group for active TB screening.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12931-023-02414-5","type":"journal-article","created":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T08:06:51Z","timestamp":1681200411000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Diabetes severity is strongly associated with the risk of active tuberculosis in people with type 2 diabetes: a nationwide cohort study with a 6-year follow-up"],"prefix":"10.1186","volume":"24","author":[{"given":"Ji Young","family":"Kang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyungdo","family":"Han","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seung-Hwan","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mee Kyoung","family":"Kim","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,4,11]]},"reference":[{"key":"2414_CR1","doi-asserted-by":"publisher","first-page":"973","DOI":"10.5588\/ijtld.15.0684","volume":"20","author":"KH Oh","year":"2016","unstructured":"Oh KH, Kim HJ, Kim MH. Non-communicable diseases and risk of tuberculosis in Korea. Int J Tuberc Lung Dis. 2016;20:973\u20137.","journal-title":"Int J Tuberc Lung Dis"},{"key":"2414_CR2","doi-asserted-by":"publisher","first-page":"730","DOI":"10.1016\/S2213-8587(14)70109-3","volume":"2","author":"K L\u00f6nnroth","year":"2014","unstructured":"L\u00f6nnroth K, Roglic G, Harries AD. Improving tuberculosis prevention and care through addressing the global diabetes epidemic: from evidence to policy and practice. Lancet Diabetes Endocrinol. 2014;2:730\u20139.","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2414_CR3","doi-asserted-by":"publisher","DOI":"10.7189\/jogh.09.020415","volume":"9","author":"SF Awad","year":"2019","unstructured":"Awad SF, Huangfu P, Ayoub HH, Pearson F, Dargham SR, Critchley JA, Abu-Raddad LJ. Forecasting the impact of diabetes mellitus on tuberculosis disease incidence and mortality in India. J Glob Health. 2019;9: 020415.","journal-title":"J Glob Health"},{"key":"2414_CR4","volume-title":"The Impact of the COVID-19 Pandemic on Noncommunicable Disease Resources and Services: Results of a Rapid Assessment, in World Health Organization","author":"World Health Organization","year":"2021","unstructured":"World Health Organization. The Impact of the COVID-19 Pandemic on Noncommunicable Disease Resources and Services: Results of a Rapid Assessment, in World Health Organization. Geneva: World Health Organization; 2021."},{"key":"2414_CR5","volume-title":"Global tuberculosis report 2021","author":"World Health Organization","year":"2021","unstructured":"World Health Organization. Global tuberculosis report 2021. Geneva: World Health Organization; 2021."},{"key":"2414_CR6","doi-asserted-by":"publisher","first-page":"688","DOI":"10.1111\/dme.13905","volume":"36","author":"SS Zghebi","year":"2019","unstructured":"Zghebi SS, Panagioti M, Rutter MK, Ashcroft DM, van Marwijk H, Salisbury C, Chew-Graham CA, Buchan I, Qureshi N, Peek N, Mallen C, Mamas M, Kontopantelis E. Assessing the severity of Type 2 diabetes using clinical data-based measures: a systematic review. Diabet Med. 2019;36:688\u2013701.","journal-title":"Diabet Med"},{"key":"2414_CR7","doi-asserted-by":"publisher","first-page":"1865","DOI":"10.1186\/s12889-021-11913-3","volume":"21","author":"T Mori","year":"2021","unstructured":"Mori T, Nagata T, Nagata M, Fujimoto K, Fujino Y, Mori K. Diabetes severity measured by treatment control status and number of anti-diabetic drugs affects presenteeism among workers with type 2 diabetes. BMC Public Health. 2021;21:1865.","journal-title":"BMC Public Health"},{"key":"2414_CR8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-012413","volume":"6","author":"R Gini","year":"2016","unstructured":"Gini R, Schuemie MJ, Mazzaglia G, Lapi F, Francesconi P, Pasqua A, Bianchini E, Montalbano C, Roberto G, Barletta V, Cricelli I, Cricelli C, Dal Co G, Bellentani M, Sturkenboom M, Klazinga N. Automatic identification of type 2 diabetes, hypertension, ischaemic heart disease, heart failure and their levels of severity from Italian General Practitioners\u2019 electronic medical records: a validation study. BMJ Open. 2016;6: e012413.","journal-title":"BMJ Open"},{"key":"2414_CR9","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.3803\/EnM.2021.1197","volume":"36","author":"BK Koo","year":"2021","unstructured":"Koo BK, Park SH, Han K, Moon MK. Cardiovascular Outcomes of Obesity According to Menopausal Status: A Nationwide Population-Based Study. Endocrinol Metab (Seoul). 2021;36:1029\u201341.","journal-title":"Endocrinol Metab (Seoul)"},{"key":"2414_CR10","doi-asserted-by":"publisher","first-page":"1007","DOI":"10.3803\/EnM.2021.1218","volume":"36","author":"SH Lee","year":"2021","unstructured":"Lee SH, Han K, Kwon HS, Kim MK. Frequency of Exposure to Impaired Fasting Glucose and Risk of Mortality and Cardiovascular Outcomes. Endocrinol Metab (Seoul). 2021;36:1007\u201315.","journal-title":"Endocrinol Metab (Seoul)"},{"issue":"43","key":"2414_CR11","doi-asserted-by":"publisher","first-page":"398","DOI":"10.4093\/dmj.2019.0137","volume":"2019","author":"MK Kim","year":"2019","unstructured":"Kim MK, Ko SH, Kim BY, Kang ES, Noh J, Kim SK, Park SO, Hur KY, Chon S, Moon MK, Kim NH, Kim SY, Rhee SY, Lee KW, Kim JH, Rhee EJ, Chun S, Yu SH, Kim DJ, Kwon HS, Park KS. Clinical Practice Guidelines for Type 2 Diabetes Mellitus in Korea. Diabetes Metab J. 2019;2019(43):398\u2013406.","journal-title":"Diabetes Metab J"},{"key":"2414_CR12","first-page":"S1","volume":"39","author":"National Kidney Foundation","year":"2002","unstructured":"National Kidney Foundation. K\/DOQI clinical practice guidelines for chronic kidney disease: Evaluation, classification, and stratification. Am J Kidney Dis. 2002;39:S1\u2013266.","journal-title":"Am J Kidney Dis"},{"key":"2414_CR13","doi-asserted-by":"publisher","first-page":"552","DOI":"10.4093\/dmj.2022.0193","volume":"46","author":"MK Kim","year":"2022","unstructured":"Kim MK, Han K, Lee SH. Current Trends of Big Data Research Using the Korean National Health Information Database. Diabetes Metab J. 2022;46:552\u201363.","journal-title":"Diabetes Metab J"},{"key":"2414_CR14","doi-asserted-by":"publisher","DOI":"10.3803\/EnM.2023.102","author":"SW Cho","year":"2023","unstructured":"Cho SW, Kim JH, Choi HS, Ahn HY, Kim MK, Rhee EJ. Big Data Research in the Field of Endocrine Diseases Using the Korean National Health Information Database. Endocrinol Metab (Seoul). 2023. https:\/\/doi.org\/10.3803\/EnM.2023.102.","journal-title":"Endocrinol Metab (Seoul)"},{"key":"2414_CR15","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.26099","volume":"4","author":"JE Yoo","year":"2021","unstructured":"Yoo JE, Kim D, Han K, Rhee SY, Shin DW, Lee H. Diabetes Status and Association With Risk of Tuberculosis Among Korean Adults. JAMA Netw Open. 2021;4: e2126099.","journal-title":"JAMA Netw Open"},{"key":"2414_CR16","doi-asserted-by":"publisher","first-page":"e973","DOI":"10.1093\/cid\/ciac411","volume":"76","author":"H Choi","year":"2023","unstructured":"Choi H, Han K, Jung JH, Park SH, Kim SH, Kang HK, Sohn JW, Shin DW, Lee H. Long-term mortality of tuberculosis survivors in Korea: a population-based longitudinal study. Clin Infect Dis. 2023;76:e973\u201381.","journal-title":"Clin Infect Dis"},{"key":"2414_CR17","unstructured":"Joint Committee for the Revision of Korean Guidelines for Tuberculosis; Korea Centers for Disease Control and Prevention. Korean guidelines for tuberculosis. Fourth edition. Cheongju: Korea Centers for Disease Control and Prevention; 2020."},{"key":"2414_CR18","unstructured":"Lin Y, Harries AD, Kumar AMV, et al. Management of diabetes tuberculosis: a guide to the essential practice. Paris, France: International Union Against Tuberculosis and Lung Disease, 2019. https:\/\/www.theunion.org\/what-we-do\/publications\/technical\/english\/TheUnion_DMTB_Guide.pdf Accessed June 2019."},{"key":"2414_CR19","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1093\/cid\/cir939","volume":"54","author":"MA Baker","year":"2012","unstructured":"Baker MA, Lin HH, Chang HY, Murray MB. The risk of tuberculosis disease among persons with diabetes mellitus: a prospective cohort study. Clin Infect Dis. 2012;54:818\u201325.","journal-title":"Clin Infect Dis"},{"key":"2414_CR20","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002072","volume":"13","author":"PH Lee","year":"2016","unstructured":"Lee PH, Fu H, Lai TC, Chiang CY, Chan CC, Lin HH. Glycemic Control and the Risk of Tuberculosis: A Cohort Study. PLoS Med. 2016;13: e1002072.","journal-title":"PLoS Med"},{"key":"2414_CR21","doi-asserted-by":"publisher","first-page":"R224","DOI":"10.1186\/cc9369","volume":"14","author":"SE Siegelaar","year":"2010","unstructured":"Siegelaar SE, Hermanides J, Oudemans-van Straaten HM, van der Voort PH, Bosman RJ, Zandstra DF, DeVries JH. Mean glucose during ICU admission is related to mortality by a U-shaped curve in surgical and medical patients: a retrospective cohort study. Crit Care. 2010;14:R224.","journal-title":"Crit Care"},{"key":"2414_CR22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0187967","volume":"12","author":"RH Al-Rifai","year":"2017","unstructured":"Al-Rifai RH, Pearson F, Critchley JA, Abu-Raddad LJ. Association between diabetes mellitus and active tuberculosis: A systematic review and meta-analysis. PLoS ONE. 2017;12: e0187967.","journal-title":"PLoS ONE"},{"key":"2414_CR23","doi-asserted-by":"publisher","first-page":"1493","DOI":"10.5588\/ijtld.15.0081","volume":"19","author":"K Al-Efraij","year":"2015","unstructured":"Al-Efraij K, Mota L, Lunny C, Schachter M, Cook V, Johnston J. Risk of active tuberculosis in chronic kidney disease: A systematic review and meta-analysis. Int J Tuberc Lung Dis. 2015;19:1493\u20139.","journal-title":"Int J Tuberc Lung Dis"},{"key":"2414_CR24","doi-asserted-by":"publisher","first-page":"1","DOI":"10.15585\/mmwr.rr6901a1","volume":"69","author":"TR Sterling","year":"2020","unstructured":"Sterling TR, Njie G, Zenner D, Cohn DL, Reves R, Ahmed A, Menzies D, Horsburgh CR Jr, Crane CM, Burgos M, LoBue P, Winston CA, Belknap R. Guidelines for the Treatment of Latent Tuberculosis Infection: Recommendations from the National Tuberculosis Controllers Association and CDC, 2020. MMWR Recomm Rep. 2020;69:1\u201311.","journal-title":"MMWR Recomm Rep"},{"key":"2414_CR25","doi-asserted-by":"publisher","first-page":"1002","DOI":"10.2215\/CJN.14471218","volume":"14","author":"S Park","year":"2019","unstructured":"Park S, Lee S, Kim Y, Lee Y, Kang MW, Cho S, Han K, Han SS, Lee H, Lee JP, Joo KW, Lim CS, Kim YS, Kim DK. Association of CKD with Incident Tuberculosis. Clin J Am Soc Nephrol. 2019;14:1002\u201310.","journal-title":"Clin J Am Soc Nephrol"},{"key":"2414_CR26","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.1017\/S0950268817000279","volume":"145","author":"MA Huaman","year":"2017","unstructured":"Huaman MA, Kryscio RJ, Fichtenbaum CJ, Henson D, Salt E, Sterling TR, Garvy BA. Tuberculosis and risk of acute myocardial infarction: a propensity score-matched analysis. Epidemiol Infect. 2017;145:1363\u20137.","journal-title":"Epidemiol Infect"},{"key":"2414_CR27","doi-asserted-by":"publisher","first-page":"15283","DOI":"10.1038\/s41598-021-94590-x","volume":"11","author":"V Chidambaram","year":"2021","unstructured":"Chidambaram V, Ruelas Castillo J, Kumar A, Wei J, Wang S, Majella MG, Gupte A, Wang JY, Karakousis PC. The association of atherosclerotic cardiovascular disease and statin use with inflammation and treatment outcomes in tuberculosis. Sci Rep. 2021;11:15283.","journal-title":"Sci Rep"},{"key":"2414_CR28","unstructured":"Korea Centers for Disease Control and Prevention. Annual report on the notified tuberculosis in Korea, 2018. Cheongju: Korea Centers for Disease Control and Prevention; 2019 [cited 2019 Apr]. https:\/\/www.kdca.go.kr\/npt\/biz\/npp\/portal\/nppPblctDtaView.do?pblctDtaSeAt=5&pblctDtaSn=2105"},{"key":"2414_CR29","volume-title":"Global Tuberculosis Report 2022","author":"World Health Organization","year":"2022","unstructured":"World Health Organization. Global Tuberculosis Report 2022. Geneva: World Health Organization; 2022."}],"container-title":["Respiratory Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12931-023-02414-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12931-023-02414-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12931-023-02414-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,11]],"date-time":"2023-04-11T08:09:47Z","timestamp":1681200587000},"score":1,"resource":{"primary":{"URL":"https:\/\/respiratory-research.biomedcentral.com\/articles\/10.1186\/s12931-023-02414-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,11]]},"references-count":29,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,12]]}},"alternative-id":["2414"],"URL":"https:\/\/doi.org\/10.1186\/s12931-023-02414-5","relation":{},"ISSN":["1465-993X"],"issn-type":[{"value":"1465-993X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,4,11]]},"assertion":[{"value":"2 February 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 April 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"11 April 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was approved by the Institutional Review Board of The Catholic University of Korea (No. SC22ZISE0045). Anonymous and deidentified information was used for analysis and, therefore, informed consent was not obtained.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"110"}}