Multicenter screening of diabetic patients for detecting new cases of tuberculosis: An approach to intensify the case detection rate of tuberculosis in developing countries with high prevalence of diabetes


Screening test
Case detection rate


Introduction: Tuberculosis (TB) is a major public health problem in most of developing countries. Meanwhile, the prevalence of type 2 diabetes mellitus (DM) is also increasing rapidly. Objectives: To describe the feasibility of implementing screening test for tuberculosis among diabetic patients and identifying factors associated with high detection rate. Methods: Study Design: Multi-center cross-sectional study. This study was implemented in the governmental healthcare settings. To diagnose TB among diabetics, we used a symptom-based questionnaire that included the symptoms of suspected TB according to the guidelines of National Tuberculosis Program in Egypt. Results: Among 4283 adult diabetics, 14 TB cases were diagnosed; 9 known TB cases and 5 newly detected cases. The number needed to detect one new case of TB was 855. Male diabetics and those suffered from liver disease experienced a significantly higher prevalence of TB and a higher detection rate of new active cases. Conclusions: Screening for TB among diabetics in routine governmental healthcare services was successfully implemented. Screening DM patients in countries with a high prevalence of DM will reveal a significant number of active TB cases, which will in turn improve the case detection rate of TB.


World Health Organization. Global tuberculosis report. 2016. Available at bitstream/10665/250441/1/9789241565394-eng.pdf?ua=1 Accessed Nov.18/2016. Accessed 24th June 2017.

International Diabetes Federation. Diabetes atlas. Seventh edition.2015. Available at: Accessed 25th Dec 2016.

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;54:818-825

Gadallah MA, Mokhtar A, Rady M, El-Moghazy E, Fawzy M & Kandil SK. Prognostic factors of treatment among patients with multidrug-resistant tuberculosis in Egypt. J Formos Med Assoc 2016;115:997-1003.

Jeon CY & Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med 2008;5. doi: 10.1371

Jeon CY, Harries AD, Baker MA, Hart JE, Kapur A, Lonnroth K et al. Bi-directional screening for tuberculosis and diabetes: a systematic review. Trop Med Int Health 2010;15:1300-1314

Workneh MH, Bjune GA, Yimer SA. Prevalence and associated factors of tuberculosis and diabetes mellitus comorbidity: A systematic review. PLoS ONE 2017; 12(4): e0175925. https://doi. org/10.1371/journal.pone.0175925

Wang H-T, Zhang J, Ji L-C,You S-H, Dai W & Wang Z-Y. Frequency of tuberculosis among diabetic patients in the People's Republic of China. Ther Clin Risk Mang 2014;10:45-49

Feleke Y1, Abdulkadir J, Aderaye G. Prevalence and clinical features of tuberculosis in Ethiopian diabetic patients. East Afr Med J 1999 ;76(7):361-364

Lin Y, Innes A, Xu L, Li L, Chen J, Hou J et al. Screening of patients with diabetes mellitus for tuberculosis in community health settings in Chine. Trop Med Int Health 2015;20:1073-1080

India Diabetes Mellitus – Tuberculosis Study Group. Screening of patients with diabetes mellitus for tuberculosis in India. Trop Med Int Health 2013;18:646-654

Castellanos-Joya M, Delgado-Sánchez G, Ferreyra-Reyes L, Cruz-Hervert P, Ferreira-Guerrero E, Ortiz-Solís G, et al. Results of the implementation of a pilot model for the bidirectional screening and joint management of patients with pulmonary tuberculosis and diabetes mellitus in Mexico. Plos One 2014; 17;9(9): e106961. doi: 10.1371

Lin YH, Chen CP, Chen PY, Huang JC, Ho C, Weng HH, Tsai YH, Peng YS. Screening for pulmonary tuberculosis in type 2 diabetes elderly: a cross-sectional study in a community hospital. BMC Public Health 2015;8;15:3. doi: 10.1186/1471-2458-15-3

Prakash BC, Ravish KS & Prabhakar B. Tuberculosis-diabetes mellitus bidirectional screening at a tertiary care center, South India. PHA 2013;3:S18-S22

Ohene SA , Bonsu F, Hanson-Nortey NN, Toonstra A, Sackey A, Lonnroth K et al. Provider initiated tuberculosis case finding in outpatient departments of health care facilities in Ghana: yield by screening strategy and target group. BMC Infectious Diseases 2017; 17:739-49. DOI 10.1186/s12879-017-2843-5

Dooley KE & Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis 2009; 9:737–746

Yorke E, Atiase Y, Akpalu J, Sarfo-KantankaO, Boima V, Dey ID. The Bidirectional Relationship between Tuberculosis and Diabetes. Tuberc Res Treat. 2017;2017:1702578. doi: 10.1155/2017/1702578

Harries AD, Satyanarayana, S, Kumar AMV, Nagaraja SB, Isaakidis P, Malhotra S et al. Epidemiology and interaction of diabetes mellitus and tuberculosis and challenges for care: a review. PHA 2013; 3:S3-S9