Analysis of Factors Including Pulmonary Tuberculosis in Diabetes Mellitus Patients

Authors

  • Marhamah Marhamah Universitas Muhammadiyah Aceh
  • Basri Aramico Ib Universitas Muhammadiyah Aceh
  • Meutia Zahara Universitas Muhammadiyah Aceh

DOI:

https://doi.org/10.37287/ijghr.v8i2.1783

Keywords:

diabetes mellitus, glycemic control, healthcare access, nutritional status, pulmonary tuberculosis

Abstract

The syndemic between Pulmonary Tuberculosis (TB) and Diabetes Mellitus (DM) is a public health challenge because DM can weaken the immune system and poor glycemic control facilitates infection by Mycobacterium tuberculosis. As the prevalence of DM in Indonesia increases, identifying risk factors that contribute to the incidence of TB in DM patients becomes important. This study aims to analyze the relationship between nutritional status, glycemic control, income level, education level, and access to health services with the incidence of pulmonary TB in DM patients. The study used an observational analytical design with a cross-sectional approach conducted at Tgk. Chik Ditiro Sigli Regional Hospital from June–September 2025 with a sample of 277 DM patients selected through purposive sampling. Data were collected using mixed methods, namely secondary data from medical records for TB status, nutritional status, and glycemic control and primary data through questionnaires for income and access to health services using the Cronbach’s Alpha method with a value of ≥0.70.The results showed that the majority of respondents did not have pulmonary TB (75.09%), but the majority had poor nutritional status (68.95%) and most had controlled glycemic control (71.12%). In addition, more than half of respondents had incomes below the Provincial Minimum Wage (56.68%) and about half had poor access to health services (50.54%). The analysis showed a significant association between poor nutritional status (AOR=2.5; 95% CI=1.17–5.39), uncontrolled glycemic control (AOR=4.5; 95% CI=2.43–8.68), income <UMP (AOR=1.9; 95% CI=1.02–3.85), and poor access to health services (AOR=3.2; 95% CI=1.65–6.30) with the incidence of pulmonary TB in DM patients,

References

Abel, T., & Benkert, R. (2022). Critical health literacy: Reflection and action for health. Health Promotion International, 37(4).

Alisjahbana, B., & Bae, S. (2018). Diabetes mellitus and tuberculosis: A review of the literature. International Journal of Infectious Diseases, 1–8.

Alisjahbana, B., Sahiratmadja, E., Nelwan, E. J., Purwa, A. M., Ahmad, Y., Ottenhoff, T. H., et al. (2007). The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clinical Infectious Diseases, 428–435.

Alisjahbana, B., et al. (2007). Diabetes mellitus and tuberculosis: A prospective study. Journal of Diabetes Research.

Alturki, S., Al Amad, M., Mahyoub, E., Al Hanash, N., & Alhammadi, A. (2023). Prevalence of diabetes mellitus among patients with tuberculosis and its associated factors in Sana'a, Yemen. Epidemiologia, 4(2), 202–211.

American Diabetes Association. (2020). Classification and diagnosis of diabetes: Standards of medical care in diabetes. Diabetes Care, S14–S31.

American Diabetes Association. (2021). Standards of medical care in diabetes. Diabetes Care, S1–S232.

Andersen, R. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 1–10.

Antonio-Arques, V., Cayla, J. A., Real, J., Moreno-Martinez, A., Orcau, A., & Mauricio, D., et al. (2022). Glycemic control and the risk of tuberculosis in patients with diabetes: A cohort study in a Mediterranean city. Frontiers in Public Health, 10, 1017024.

Badawi, A., Gregg, B., & Vasileva, D. (2020). Systematic analysis for the relationship between obesity and tuberculosis. Public Health, 186, 246–256.

Bae, S. H., et al. (2019). Diabetes and the risk of tuberculosis: A systematic review and meta-analysis. Diabetes Care, 1410–1417.

Baker, M. A., Harrington, M., et al. (2011). The impact of diabetes on tuberculosis treatment outcomes: A systematic review. International Journal of Tuberculosis and Lung Disease, 1288–1294.

Banilai, P., & Sakundarno, M. (2023). Faktor-faktor yang berhubungan dengan kejadian diabetes melitus pada penderita tuberkulosis. Healthy Tadulako Journal, 9, 205–217.

Choi, H., Yoo, J. E., Han, K., Choi, W., Rhee, S. Y., Lee, H., & Shin, D. W. (2021). Body mass index, diabetes, and risk of tuberculosis: A retrospective cohort study. Frontiers in Nutrition, 8, 739766.

Dobler, C. C., et al. (2012). Risk of tuberculosis among people with diabetes mellitus: An Australian nationwide cohort study. BMJ Open, 1–8.

Elsa, A., Antoro, B., & Sari, N. N. (2025). Faktor-faktor yang berhubungan dengan peningkatan kadar gula darah pada pasien tuberkulosis. Journal of Qualitative Health Research & Case Studies Reports, 5(4), 564–572.

Fâcă, A. I., Udeanu, D. I., Arsene, A. L., Mahler, B., Drăgănescu, D., & Apetroaei, M. M. (2025). Nutritional deficiencies and management in tuberculosis: Pharmacotherapeutic and clinical implications. Nutrients, 17(11).

Farrah, F., & Akbar, F. (2025). Socioeconomic, behavioral, and biological determinants of tuberculosis incidence: A case study in Aceh Besar, Indonesia. Journal of Public Health and Pharmacy, 5(3), 532–548.

Geerlings, S. E., & Hoepelman, A. I. M. (1999). Immune dysfunction in patients with diabetes mellitus. FEMS Immunology & Medical Microbiology, 259–265.

Gonzalez, C., et al. (2018). Diabetes and tuberculosis: A global health perspective. Diabetes Research and Clinical Practice, 1–9.

Goshrani, A., Lin, R., O’Neal, D., & Ekinci, E. I. (2025). Time in range: A new gold standard in type 2 diabetes research? Diabetes, Obesity and Metabolism, 27(5), 2342–2362.

International Diabetes Federation. (2021). IDF diabetes atlas (10th ed.). Brussels: IDF.

Jeon, C. Y., & Murray, M. B. (2008). Diabetes increases the risk of active tuberculosis: A systematic review. Diabetes Care, 1892–1899.

Kementerian Kesehatan Republik Indonesia. (2020). Laporan situasi TB nasional. Jakarta: Kemenkes RI.

Kementerian Kesehatan Republik Indonesia. (2021). Laporan situasi tuberkulosis di Indonesia. Jakarta: Kemenkes RI.

Kementerian Kesehatan Republik Indonesia. (2022). Data dan informasi kesehatan. Jakarta: Kemenkes RI.

Khan, F. U., Khan, F. U., Hayat, K., Chang, J., Kamran, M., Khan, A., et al. (2021). Impact of protracted displacement on delay in the diagnosis associated with treatment outcomes. International Journal of Environmental Research and Public Health, 18(22).

Kumar, A., et al. (2015). Diabetes and tuberculosis: A review of the literature. Diabetes Research and Clinical Practice, 1–10.

Kumar, A., et al. (2021). The relationship between diabetes and tuberculosis: A review. Journal of Diabetes Research, 1–9.

Kumar, S., et al. (2020). Mechanisms of immune dysfunction in diabetes and its implications for tuberculosis. Clinical Microbiology Reviews, e00028-19.

Leung, C. C., et al. (2008). Diabetic control and risk of tuberculosis: A cohort study. American Journal of Epidemiology.

Lönnroth, K., Jaramillo, E., Williams, B. G., Dye, C., & Raviglione, M. (2009). Drivers of tuberculosis epidemics: The role of risk factors and social determinants. Social Science & Medicine, 2240–2246.

Lönnroth, K., Roglic, G., & Harries, A. D. (2010). Global epidemiology of diabetes and tuberculosis. Diabetes Care, 2157–2161.

Maharani, R., Karima, U. Q., & Kamilia, K. (2022). Socio-demographic and behavioral factors relationship with pulmonary tuberculosis: A case-control study. Open Access Macedonian Journal of Medical Sciences, 10, 130–135.

Marais, B. J., Lönnroth, K., Lawn, S. D., Migliori, G. B., et al. (2013). Tuberculosis comorbidity with communicable and non-communicable diseases. Lancet Infectious Diseases, 436–448.

Menzies, D., et al. (2016). Diabetes and tuberculosis: A double burden for the world. The Lancet Diabetes & Endocrinology, 283–292.

Mitra, S., Paul, S., Roy, S., Sutradhar, H., Emran, T. B., Nainu, F., et al. (2022). Exploring the immune-boosting functions of vitamins and minerals. Molecules, 27(2).

Nugrahaeni, D. K., Kusumasari, I., Budiana, T. A., & Mauliku, N. E. (2025). Factors associated with tuberculosis–diabetes mellitus comorbidity. Jurnal Berkala Epidemiologi, 13(1), 75–84.

Nuraisyah, F., Juliana, N., Astria, D., Khalisah, N., Miftahul, D., Kurnia, S., et al. (2024). Risk factors of pulmonary tuberculosis in type 2 diabetes mellitus in Yogyakarta. Journal of Epidemiology and Public Health, 9(2), 194–203.

O’Grady, J., et al. (2019). The impact of environmental factors on tuberculosis incidence. Environmental Research.

Restrepo, B. I., et al. (2008). Diabetes and tuberculosis: A dangerous association. Clinical Infectious Diseases, 503–507.

Restrepo, B. I., et al. (2008). Diabetes and tuberculosis: A global epidemic. Diabetes Care, 1243–1249.

Skalická, V., Van Lenthe, F., Bambra, C., Krokstad, S., & Mackenbach, J. (2009). Factors explaining socioeconomic inequalities in mortality. International Journal of Epidemiology, 38(5), 1272–1284.

Van Crevel, R., & Critchley, J. A. (2021). The interaction of diabetes and tuberculosis. Tropical Medicine and Infectious Disease, 6(1).

Wang, J., et al. (2017). The impact of diabetes on tuberculosis treatment outcomes. BMC Infectious Diseases.

World Health Organization. (2021). Global tuberculosis report 2021. Geneva: WHO.

World Health Organization. (2023). Global tuberculosis report 2023. Geneva: WHO.

Yapislar, H., & Gurler, E. B. (2024). Management of microcomplications of diabetes mellitus. Biomedicines, 12(9).

Zhao, L., Gao, F., Zheng, C., & Sun, X. (2024). The impact of optimal glycemic control on tuberculosis treatment outcomes in patients with diabetes mellitus. JMIR Public Health and Surveillance, 10, e53948.

Downloads

Published

2026-04-13

How to Cite

Marhamah, M., Ib, B. A., & Zahara , M. (2026). Analysis of Factors Including Pulmonary Tuberculosis in Diabetes Mellitus Patients. Indonesian Journal of Global Health Research, 8(2), 1121–1132. https://doi.org/10.37287/ijghr.v8i2.1783

Similar Articles

<< < 24 25 26 27 28 29 30 31 32 33 > >> 

You may also start an advanced similarity search for this article.