• adherence;
  • cohort study;
  • diabetes mellitus;
  • National Health Insurance Database;
  • tuberculosis;
  • pharmacoepidemiology



Diabetic mellitus (DM) is a well-known risk factor of tuberculosis (TB). However, there is paucity of reports on the impact of diabetic control and adherence to anti-diabetic treatment on the risk of TB. This nationwide cohort study aimed to address these issues.


In the Longitudinal Health Insurance Database 2005 of Taiwan, DM cases and matched control subjects were selected. Potential risk factors for developing TB were investigated using the Cox proportional hazards regression analysis. Time-dependent variables were used to measure drug prescription, adherence, and number of DM-associated admissions from 360 to 90 days prior to each outcome event.


The 49 903 DM patients identified (52.5% males) had a mean age of 61.9 ± 14.2 years. Among DM patients and control subjects, the independent risk factors of TB were age, male sex, chronic obstructive pulmonary disease (COPD), autoimmune disease, and DM (hazard ratio [HR] 1.293 [1.154–1.449]). Among DM patients, time-dependent Cox analysis revealed that age, male sex, COPD, end-stage renal disease, maximum average daily dose of oral hypoglycemic agent (HR 1.13 [1.071–1.193]), insulin use during admission (HR 1.462 [1.087–1.966]), adherence to anti-diabetic medication (0.577 [0.429–0.776]), and number of DM-associated admissions (1.789 [1.231–2.601]) were independent factors associated with the development of TB.


The risk of TB parallels DM severity. Some cases of TB can be prevented by fostering adherence to anti-diabetic medication. Copyright © 2013 John Wiley & Sons, Ltd.