Differential Role of Type 2 Diabetes as a Risk Factor for Tuberculosis in the Elderly versus Younger Adults
Blanca I. Restrepo,
Julia M. Scordo,
Génesis P. Aguillón-Durán,
Doris Ayala,
Ana Paulina Quirino-Cerrillo,
Raúl Loera-Salazar,
America Cruz-González,
Jose A. Caso,
Mateo Joya-Ayala,
Esperanza M. García-Oropesa,
Alejandra B. Salinas,
Leonardo Martinez,
Larry S. Schlesinger,
Jordi B. Torrelles,
Joanne Turner
Affiliations
Blanca I. Restrepo
School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
Julia M. Scordo
Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
Génesis P. Aguillón-Durán
Secretaría de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Mexico
Doris Ayala
School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
Ana Paulina Quirino-Cerrillo
School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
Raúl Loera-Salazar
Secretaría de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Mexico
America Cruz-González
Secretaría de Salud de Tamaulipas, Reynosa 88630, Matamoros 87370 and Ciudad Victoria 87000, Mexico
Jose A. Caso
Biology Department, University of Texas Rio Grande Valley, Edinburg, TX 78541, USA
Mateo Joya-Ayala
School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
Esperanza M. García-Oropesa
Unidad Académica Multidisciplinaria Reynosa-Aztlán, Universidad Autónoma de Tamaulipas Reynosa-Aztlán, Reynosa 88779, Mexico
Alejandra B. Salinas
School of Public Health and UTHealth Consortium on Aging, University of Texas Health Science Center at Houston, Brownsville Campus, Brownsville, TX 78520, USA
Leonardo Martinez
Department of Epidemiology, School of Public Health, Boston University, Boston, MA 02118, USA
Larry S. Schlesinger
Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
Jordi B. Torrelles
Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
Joanne Turner
Host Pathogen Interactions and Population Health Program, Texas Biomedical Research Institute, San Antonio, TX 78227, USA
The elderly are understudied despite their high risk of tuberculosis (TB). We sought to identify factors underlying the lack of an association between TB and type 2 diabetes (T2D) in the elderly, but not adults. We conducted a case–control study in elderly (≥65 years old; ELD) vs. younger adults (young/middle-aged adults (18–44/45–64 years old; YA|MAA) stratified by TB and T2D, using a research study population (n = 1160) and TB surveillance data (n = 8783). In the research study population the adjusted odds ratio (AOR) of TB in T2D was highest in young adults (AOR 6.48) but waned with age becoming non-significant in the elderly. Findings were validated using TB surveillance data. T2D in the elderly (vs. T2D in younger individuals) was characterized by better glucose control (e.g., lower hyperglycemia or HbA1c), lower insulin resistance, more sulphonylureas use, and features of less inflammation (e.g., lower obesity, neutrophils, platelets, anti-inflammatory use). We posit that differences underlying glucose dysregulation and inflammation in elderly vs. younger adults with T2D, contribute to their differential association with TB. Studies in the elderly provide valuable insights into TB-T2D pathogenesis, e.g., here we identified insulin resistance as a novel candidate mechanism by which T2D may increase active TB risk.
