{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T01:24:23Z","timestamp":1776907463668,"version":"3.51.2"},"reference-count":30,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T00:00:00Z","timestamp":1609718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004595","name":"Universiti Sains Malaysia","doi-asserted-by":"publisher","award":["304\/PPSP\/61313027"],"award-info":[{"award-number":["304\/PPSP\/61313027"]}],"id":[{"id":"10.13039\/501100004595","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Type 2 diabetes mellitus (T2DM) and tuberculosis (TB) together impose a high disease burden in terms of both mortality and health economics worldwide. The objective of this study was to estimate the prevalence and risk factors of latent TB infection (LTBI) in patients with T2DM in Malaysia. A cross-sectional study was performed, and adult T2DM patients (n = 299) were included. Simple and multiple logistic regression analyses were performed to identify the LTBI-associated risk factors in patients with T2DM. Multiple logistic regression was used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CIs) between T2DM and LTBI and was adjusted for potential confounders. The prevalence of LTBI in patients with T2DM was 11.4% (95% CI: 8.0\u201315.0%). There was no significant difference in the socio-demographic characteristics between LTBI and non-LTBI subjects. No significant difference in the smoking status, the duration of smoking, and the duration of T2DM, HbA1c, or treatments was observed. Interestingly, a higher level of education was observed to be associated with a lower prevalence of LTBI in T2DM patients (aOR: 0.08, 95% CI: 0.01\u20130.70, p = 0.02). Although the prevalence of LTBI in T2DM was low, it is important to screen for it in T2DM patients due to the risk of developing severe active TB.<\/jats:p>","DOI":"10.3390\/ijerph18010305","type":"journal-article","created":{"date-parts":[[2021,1,4]],"date-time":"2021-01-04T03:00:51Z","timestamp":1609729251000},"page":"305","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Prevalence and Risk Factors of Latent Tuberculosis Infection (LTBI) in Patients with Type 2 Diabetes Mellitus (T2DM)"],"prefix":"10.3390","volume":"18","author":[{"given":"Phan Ai","family":"Ping","sequence":"first","affiliation":[{"name":"Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7093-8278","authenticated-orcid":false,"given":"Rosnani","family":"Zakaria","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5937-6473","authenticated-orcid":false,"given":"Md Asiful","family":"Islam","sequence":"additional","affiliation":[{"name":"Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1296-0482","authenticated-orcid":false,"given":"Lili Husniati","family":"Yaacob","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosediani","family":"Muhamad","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wan Mohamad Zahiruddin","family":"Wan Mohamad","sequence":"additional","affiliation":[{"name":"Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Harmy Mohamed","family":"Yusoff","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu 21300, Terengganu, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,4]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2019). Global Tuberculosis Report 2019, WHO."},{"key":"ref_2","unstructured":"World Health Organization (2018). Latent TB Infection: Updated and Consolidated Guidelines for Programmatic Management, WHO."},{"key":"ref_3","unstructured":"Sanjay, R., and Arora, V. (2020). Latent TB (LTBI) treatment: Challenges in India with an EYE on 2025. Indian J. Tuberc."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Houben, R.M., and Dodd, P.J. (2016). The global burden of latent tuberculosis infection: A re-estimation using mathematical modelling. PLoS Med., 13.","DOI":"10.1371\/journal.pmed.1002152"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1001\/archinte.163.9.1009","article-title":"The growing burden of tuberculosis: Global trends and interactions with the HIV epidemic","volume":"163","author":"Corbett","year":"2003","journal-title":"Arch. Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1627","DOI":"10.2174\/1389557519666190625165512","article-title":"Latent tuberculosis infection (LTBI) and its potential targets: An investigation into dormant phase pathogens","volume":"19","author":"Gutti","year":"2019","journal-title":"Mini Rev. Med. Chem."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e022445","DOI":"10.1136\/bmjopen-2018-022445","article-title":"Screening and prevention for latent tuberculosis in immunosuppressed patients at risk for tuberculosis: A systematic review of clinical practice guidelines","volume":"8","author":"Hasan","year":"2018","journal-title":"BMJ Open"},{"key":"ref_8","first-page":"719","article-title":"Diabetes mellitus and latent tuberculosis infection: A systemic review and metaanalysis","volume":"64","author":"Lee","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Villa, S., Ferrarese, M., Sotgiu, G., Castellotti, P.F., Saderi, L., Grecchi, C., Saporiti, M., Raviglione, M., and Codecasa, L.R. (2020). Latent tuberculosis infection treatment completion while shifting prescription from isoniazid-only to rifampicin-containing regimens: A two-decade experience in Milan, Italy. J. Clin. Med., 9.","DOI":"10.3390\/jcm9010101"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Emerging Risk Factors Collaboration (2010). Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: A collaborative meta-analysis of 102 prospective studies. Lancet, 375, 2215\u20132222.","DOI":"10.1016\/S0140-6736(10)60484-9"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.diabres.2013.11.002","article-title":"Global estimates of diabetes prevalence for 2013 and projections for 2035","volume":"103","author":"Guariguata","year":"2014","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Jeon, C.Y., and Murray, M.B. (2008). Diabetes mellitus increases the risk of active tuberculosis: A systematic review of 13 observational studies. PLoS Med., 5.","DOI":"10.1371\/journal.pmed.0050181"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.diabres.2012.12.001","article-title":"The double burden of diabetes and tuberculosis\u2014Public health implications","volume":"101","author":"Kapur","year":"2013","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1111\/j.1365-3156.2010.02523.x","article-title":"Defining the research agenda to reduce the joint burden of disease from diabetes mellitus and tuberculosis","volume":"15","author":"Harries","year":"2010","journal-title":"Trop. Med. Int. Health"},{"key":"ref_15","unstructured":"World Health Organization (2018). Prevalence of Diabetes in the WHO Western Pacific Region, WHO."},{"key":"ref_16","unstructured":"World Health Organization (2018). Tuberculosis Profile, WHO."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"214","DOI":"10.2174\/1573404814666180906125843","article-title":"Prevalence of Latent Tuberculosis (LTB) Among Pregnant Women in a High Burden Setting in Sudan using Interferon Gamma (IFN-\u03b3) Releasing Assay (IGRA)","volume":"15","author":"Yassin","year":"2019","journal-title":"Curr. Womens Health Rev."},{"key":"ref_18","first-page":"154","article-title":"Tuberculin test in diabetic patients in a health center","volume":"16","author":"Mansilla","year":"1995","journal-title":"Aten. Primaria"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"366","DOI":"10.1016\/j.diabres.2018.03.022","article-title":"Diabetes is associated with increased prevalence of latent tuberculosis infection: Findings from the National Health and Nutrition Examination Survey, 2011\u20132012","volume":"139","author":"Barron","year":"2018","journal-title":"Diabetes Res. Clin. Pract."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"277","DOI":"10.4103\/ejcdt.ejcdt_85_19","article-title":"Latent tuberculosis infection among patients with type 2 diabetes mellitus","volume":"69","author":"Agha","year":"2020","journal-title":"Egypt. J. Chest Dis. Tuberc."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1055\/s-0034-1377044","article-title":"Latent tuberculosis in patients with diabetes mellitus: Prevalence, progression and public health implications","volume":"122","author":"Leow","year":"2014","journal-title":"Exp. Clin. Endocrinol. Diabetes"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.arcmed.2015.03.009","article-title":"Associated risk factors for latent tuberculosis infection in subjects with diabetes","volume":"46","author":"Serrano","year":"2015","journal-title":"Arch. Med. Res."},{"key":"ref_23","first-page":"892","article-title":"Prevalence and determinants of positive tuberculin reactions of residents in old age homes in Hong Kong","volume":"10","author":"Cheung","year":"2006","journal-title":"Int. J. Tuberc. Lung Dis."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.humimm.2011.03.027","article-title":"Differential expression of antimicrobial peptides in active and latent tuberculosis and its relationship with diabetes mellitus","volume":"72","author":"Araujo","year":"2011","journal-title":"Hum. Immunol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.cyto.2015.12.026","article-title":"Type 2 diabetes mellitus coincident with pulmonary or latent tuberculosis results in modulation of adipocytokines","volume":"79","author":"Kumar","year":"2016","journal-title":"Cytokine"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1093\/fampra\/cmx017","article-title":"Epidemiology of latent tuberculosis infection among patients with and without diabetes mellitus","volume":"34","author":"Nantha","year":"2017","journal-title":"Fam. Pract."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1136\/thorax.57.9.804","article-title":"A meta-analysis of the effect of Bacille Calmette Guerin vaccination on tuberculin skin test measurements","volume":"57","author":"Wang","year":"2002","journal-title":"Thorax"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"281","DOI":"10.2174\/0929866526666190119165805","article-title":"Diagnostic Accuracy of Monocyte Chemotactic Protein (MCP)-2 as Biomarker in Response to PE35\/PPE68 Proteins: A Promising Diagnostic Method for the Discrimination of Active and Latent Tuberculosis","volume":"26","author":"Mamishi","year":"2019","journal-title":"Protein Pept. Lett."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"384","DOI":"10.3109\/00365548.2014.885657","article-title":"Diabetes is associated with lower tuberculosis antigen-specific interferon gamma release in Tanzanian tuberculosis patients and non-tuberculosis controls","volume":"46","author":"Aabye","year":"2014","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1016\/j.ijid.2019.02.018","article-title":"Latent tuberculosis infection and non-infectious co-morbidities: Diabetes mellitus type 2, chronic kidney disease and rheumatoid arthritis","volume":"80","author":"Kirwan","year":"2019","journal-title":"Int. J. Infect. Dis."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/1\/305\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:06:37Z","timestamp":1760159197000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/1\/305"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,4]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1]]}},"alternative-id":["ijerph18010305"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18010305","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,4]]}}}