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Associations between Diabetes Mellitus and Nontuberculous Mycobacterium-Caused Diseases in Taiwan: A Nationwide Cohort Study

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  • 1 Department of Family Medicine, Tri-Service General Hospital SongShan Branch, National Defense Medical Center, Taipei City, Taiwan;
  • | 2 Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei City, Taiwan;
  • | 3 Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan;
  • | 4 Division of Infection, Department of Medicine, Tri-Service General Hospital SongShan Branch, National Defense Medical Center, Taipei City, Taiwan;
  • | 5 School of Public Health, National Defense Medical Center, Taipei City, Taiwan;
  • | 6 Taiwanese Injury Prevention and Safety Promotion Association, Taipei City, Taiwan;
  • | 7 Department of Medicine, Mackay Medical College, New Taipei City, Taiwan;
  • | 8 Graduate Institute of Pathology and Parasitology, National Defense Medical Center, Taipei City, Taiwan;
  • | 9 Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan;
  • | 10 Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan;
  • | 11 Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan;
  • | 12 Graduate Institute of Life Sciences, National Defense Medical Center, Taipei City, Taiwan

ABSTRACT.

Patients with diabetes mellitus (DM) are at greater risk of developing active tuberculosis and other intracellular bacterial infections, although the risk of acquiring infections from nontuberculous Mycobacterium (NTM) remains undefined. This study evaluated associations between DM and incidence of NTM infection-caused pulmonary and cutaneous diseases. Data for DM patients were extracted from the National Health Insurance Research Database of Taiwan. The DM cohort included 136,736 patients, and cases were matched randomly by age, gender, and index year with non-DM patients. Multivariate Cox proportional hazards regression was used to calculate adjusted hazard ratios of incident NTM-caused diseases in the DM cohort compared with non-DM control subjects. The frequency of incident NTM-caused diseases was significantly greater in DM patients (0.12%) than in non-DM patients (0.08%) (P < 0.05), including patients with type 1 DM (0.12%) and type 2 DM (0.12%) (all P < 0.05). Adjusted multivariate Cox regression analysis revealed that the incidence of NTM-caused diseases in DM patients was 1.43-fold greater than that in non-DM patients overall (P < 0.05), particularly in pulmonary (1.13-fold), other specific (excluding pulmonary, cutaneous, and disseminated diseases; 3.88-fold), and unspecific (atypical NTM infection; 1.54-fold) diseases (all P < 0.05). In conclusion, both type 1 DM and type 2 DM patients have high risk of NTM-caused diseases, suggesting that physicians need to pay more attention to this issue concerning the high risk of NTM-caused infection in DM patients.

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Author Notes

Address correspondence to Wu-Chien Chien, Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Cheng-Kung Road, Neihu District, Taipei City, 11490, Taiwan, E-mail: chienwu@ndmctsgh.edu.tw or Jong-Long Guo, Department of Health Promotion and Health Education, National Taiwan Normal University, No. 162, Section 1, Heping E. Road, Taipei City 106, Taiwan, E-mail: jonglong@ntnu.edu.tw.

Financial support: This work was supported by the Tri-Service General Hospital Songshan Branch, Taiwan (TSGH-SSD-108018) to J.-Y.W., and the Tri-Service General Hospital, Taiwan (TSGH-B-109010 and TSGH-B-110012) to W.-C.C and (TSGH-D-110098) to HCL, and Ministry of National Defense Medical Affairs Bureau, Taiwan (MND-MAB-110-110) to HCL.

Authors’ addresses: Jui-Yang Wang, Department of Family Medicine, Tri-Service General Hospital SongShan Branch, National Defense Medical Center, Taipei City, Taiwan, and Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei City, Taiwan, E-mail: garywawa@yahoo.com.tw. Hsin-Chung Lin, Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, E-mail: hsinchunglin@gmail.com. Hsin-An Lin, Division of Infection, Department of Medicine, Tri-Service General Hospital SongShan Branch, National Defense Medical Center, Taipei City, Taiwan, E-mail: shinean0928@gmail.com. Chi-Hsiang Chung, School of Public Health, National Defense Medical Center, Taipei City, Taiwan, and Taiwanese Injury Prevention and Safety Promotion Association, Taipei City, Taiwan, E-mail: g694810042@gmail.com. Lih-Chyang Chen, Department of Medicine, Mackay Medical College, New Taipei City, Taiwan, E-mail: lihchyang@mmc.edu.tw. Kuo-Yang Huang, Graduate Institute of Pathology and Parasitology, National Defense Medical Center, Taipei City, Taiwan, E-mail: cguhgy6934@gmail.com. Chien-An Sun, Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, and Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan, E-mail: 040866@mail.fju.edu.tw. Wu-Chien Chien, School of Public Health, National Defense Medical Center, Taipei City, Taiwan, Taiwanese Injury Prevention and Safety Promotion Association, Taipei City, Taiwan, Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei City, Taiwan, and Graduate Institute of Life Sciences, National Defense Medical Center, Taipei City, Taiwan, E-mail: chienwu@ndmctsgh.edu.tw. Jong-Long Guo, Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei City, Taiwan, E-mail: jonglong@ntnu.edu.tw.

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