| Background and Objectives Pulmonary tuberculosis with type 2 diabetes mellitus(PTB-DM) refers to the concurrent syndrome of pulmonary tuberculosis(PTB) and type 2 diabetes mellitus(DM),which could make more dangerous condition, difficult treatment and poor prognosis, and put forward a severe challenge for global public health. At present, there is an increasing trend in the incidence of PTB-DM. Studies in view of the standardly managed PTB patients with DM and the associated factors on the disease were rare. Both PTB and DM are wasting diseases, so dietary nutrition and lifestyle play important roles in development of PTB and DM. It was reported that body weight loss, content of macro and trace elements decline could appear with the progress of diseases, but studies of nutrition status and living habits of PTB-DM patients were less. For understanding the prevalence of PTB-DM in eastern and western areas in China, we planed to carry out the analysis of epidemic situation in PTB-DM patients in Linyi city of Shandong province and Gansu province, and compared the differences in different regions to explore related factors.What’s more, we conducted a specific health knowledge education for patients to provide the basis for comprehensive prevention and control strategy.Methods This study included three parts. The first part was the epidemic situation of PTB-DM patients. Cross-sectional survey was used in this study. 10416 PTB patients from seven counties in Linyi city of Shandong province and 17 areas in Gansu province in China were selected, who were all new diagnosed and registered in DOTS from September 2010 to March 2013. At the same time, 8829 non-PTB control people were selected too, who did not have PTB and randomly sampled in the same area. Measures for screening DM was extracting fasting venous blood or fingertip blood, and then analyzed the epidemic situation of PTB patients with DM or impaired fasting glucose(IFG). Also, height and weight were measured, and questionnaires were investigated, including the basic characteristics, lifestyle, and 24-hour Dietary Recalls. The second part was analysis of associated factors of PTB-DM. The objects can be divided into four groups according to the with or without PTB and DM, which were PTB-DM group(n=687), PTB group(n=4459), DM group(n=435) and control group(n=3309), respectively. Research contents contained detection of plasma glucose, lipids and hemoglobin, measurement of height and weight, questionnaire including general conditions, lifestyle and semi-quantitative food frequency questionnaires. Multiple Logistic Regression was used to analyzed the risk of associated factors. The third part was intervention of health education for PTB-DM patients. From September 2010 to July2012, comprehensive PTB-DM health educations were carried out for all the objects, and then part of PTBpatients were randomly selected to evaluate the effect of health education. The objects were also divided into four groups, which were PTB-DM group(n=86), PTB group(n=372), DM group(n=47) and control group(n=239), and were surveyed on awareness of disease prevention and nutritional knowledge. The improvement of lifestyle was analyzed in a random sample of PTB-DM in a town, in order to acquire preliminary evaluation of the effect. This study had been given the approval of ethics committee of Qingdao municipal center for disease control and prevention, and the clinical registration number was Chi CTR-OCC-10000994.Results The results of epidemic situation in PTB-DM were showed that DM and IFG prevalence in PTB patients were 4.9% and 7.0%, which were both significantly higher than the prevalence in control group(3.8% and 5.5%, P<0.05). The risk of DM and IFG in PTB patients were 1.32 times(95% CI: 1.15-1.52) and 1.30 times(95% CI: 1.16-1.16)compared with control groups, respectively. In addition, the prevalence of DM and IFG in PTB patients in Shandong province were 5.9% and7.2%, which were both significantly higher than those in Gansu province(P<0.05). The average ages of PTB-DM patients in shandong province and gansu province(56.22 years and 58.31 years) were significantly higher than local PTB patients, while there was no difference about gender ratio between the two groups(P > 0.05).The results of analysis of nutritional status and risk in PTB-DM showed that BMI means of PTB-DM and PTB groups were 21.1 kg/m2 and 21.0 kg/m2, which were significantly lower than that of DM and control groups(P<0.05). The proportion of underweight in TB+DM group was 21.4%, significantly higher than the other three groups(P<0.05). Overweight accounted for 15.9% in PTB-DM group, significantly higher than that of PTB group, and obesity significantly accounted lowest(0.6%) in all groups(P<0.05). By Multiple Logistic Regression, underweight could increase the risk of PTB-DM and PTB(OR=2.38, 95% CI: 1.74-3.26; OR=2.02, 95% CI: 1.74-2.34); while overweight could decrease the risk of PTB(OR=0.62, 95% CI: 0.55-0.71), and obesity also decreased the risk of PTB-DM and PTB(P<0.05).It was showed in analysis of associated factors on PTB-DM that smoking in PTB-DM and PTB groups accounted for 25.2% and 23.3%, which were significantly higher than DM and control groups(P<0.05). The proportion of often ventilation and outdoor activities >2 hours in PTB-DM group were both significantly lower than control group(P<0.05). Furthermore, smoking was the risk factor for PTB-DM and PTB, of which ORs(95% CI) were 1.41(1.03-1.91) and 1.52(1.33-1.73), and outdoor activities >2 hours was protective factor for PTB-DM and PTB groups(P<0.05).According to the investigation results of awareness, PTB-DM and PTB groups were poorer in awareness on knowledge of dietary nutrition, PTB and DM, especially some ofthe awareness rate of questions about nutrients and diabetes knowledge were less than10%. After the intervention, the proportion of smoking had decreases from 66.7% to30.4%(P<0.05), while the percentages of often ventilation and outdoor activities > 2hours had obviously increased(P<0.05). Also, he fasting glucose levels has been reduced from 11.10 mmol/L to 7.39 mmol/L in PTB-DM group(P<0.05). It was obviously related to medical treatment in time, and improved dietary nutrition and lifestyle might also have played a positive role.Conclusions Prevalence of DM in PTB patients was significantly higher than that in local controls.In eastern areas(Linyi city of Shandong province), the prevalence of DM and IFG in PTB patients were significantly higher than western areas(Gansu province). BMI and lifestyle may play important roles in PTB-DM, and underweight could increases the risk of PTB-DM. The bad lifestyles could be improved by effective health guidance and health education, include smoking cessation, often ventilation, and outdoor activities > 2 hours a day, which achieved good results in treatment and prognosis of PTB-DM. Therefore, this study would provide a scientific basis for two-way effective prevention and control of PTB and DM.
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