Keywords: Risk-factors, Pulmonary-Tuberculosis, Diabetes-Mellitus, Prevalence, Indonesia


Diabetes mellitus (DM) is a well-known risk factor for tuberculosis (TB). Prevalence of TB among DM patients ranged from 1.7 % to 36 %. Limited information has been reported regarding TB among DM patients in Indonesia. This case-control study aimed to investigate prevalence and related factors of pulmonary TB among DM patients in Dr. Kariadi General Hospital. Cases of pulmonary TB were defined by a positive acid-fast bacilli smear or molecular rapid test and thorax x-ray. Data were presented as frequency and percentage comparing the case and control group. Chi-square continued by Binary logistic regression analyses were done to determine the relationship between the parameters and TB status performed by the SPSS 16. Prevalence of 8.02% or 72 patients were diagnosed as having pulmonary TB from 898 registered patients with DM. Of the 72 TB patients, 30 completed the data as case group, and 45 DM patients without TB determined as a control group. Comparison between the case and control group study found differences in household contact (63.3 % and 4.4 %, respectively), random plasma glucose (76.7 % and 33.3 %), duration of DM (40 % and 71 %), and treatment compliance (30 % and 68.9 %). The final   model in Binary logistic regression involved household contact, random plasma glucose level, and treatment compliance. The prevalence of pulmonary TB among DM patients in Dr. Kariadi General Hospital was 8.02%. Risk factors that were associated with this occurrence were: household contact, high random plasma glucose level, and poor treatment compliance.


WHO. Global tuberculosis report 2017. Switzerland; 2017.

Singh K, Narayan KMV, Eggleston K. Economic Impact of Diabetes in South Asia: the Magnitude of the Problem. Curr Diab Rep. 2019;19(6).

Lange C, Abubakar I, Alffenaar JWC, Bothamley G, Caminero JA, Carvalho ACC, et al. Management of patients with multidrugresistant/ extensively drug-resistant tuberculosis in Europe: A TBNET consensus statement. Eur Respir J. 2014;44(1):23–63.

Pande T, Huddart S, Xavier W, Kulavalli S, Chen T, Pai M, et al. Prevalence of diabetes mellitus amongst hospitalized tuberculosis patients at an Indian tertiary care center: A descriptive analysis. PLoS One. 2018;13(7):1–13.

Hoa NB, Phuc PD, Hien NT, Hoa VQ, Thuong PH, Anh PT, et al. Prevalence and associated factors of diabetes mellitus among tuberculosis patients in Hanoi, Vietnam. BMC Infect Dis. 2018;18(1):1–9.

Da Costa JC, Oliveira O, Baía L, Gaio R, Correia-Neves M, Duarte R. Prevalence and factors associated with diabetes mellitus among tuberculosis patients: A nationwide cohort. Eur Respir J. 2016;48(1):264–8.

Restrepo BI. Diabetes and tuberculosis fact sheet. 2016;18(May):32–6.

Jeon CY, Harries AD, Baker MA, Hart JE, Kapur A, Lönnroth K, et al. Bi-directional screening for tuberculosis and diabetes: A systematic review. Trop Med Int Heal. 2010;15(11):1300–14.

Workneh MH, Bjune GA, Yimer SA. Prevalence and associated factors of tuberculosis and diabetes mellitus comorbidity: A systematic review1. Workneh MH, Bjune GA, Yimer SA. Prevalence and associated factors of tuberculosis and diabetes mellitus comorbidity: A systematic review. [cited 201. 2017;1–25.

Zimmet PZ, Magliano DJ, Herman WH, Shaw JE. Diabetes : a 21st century challenge. LANCET Diabetes Endocrinol. 2014;2(1):56–64.

Forouhi NG, Wareham NJ. Epidemiology of diabetes. Medicine (Abingdon, England : UK ed.). 2014;42(12):698–702.

Koesoemadinata RC, McAllister SM, Soetedjo NNM, Ratnaningsih DF, Ruslami R, Kerry S, et al. Latent TB infection and pulmonary TB disease among patients with diabetes mellitus in Bandung, Indonesia. Trans R Soc Trop Med Hyg. 2017;111(2):81–9.

Lemeshow S, Jr DWH, Klar J of M, Lwanga SK, Organization) (World Health. Adequacy of Sample Size in Health Studies. World Health Organization; 1990.

BADAN PUSAT STATISTIK. Peraturan Kepala Badan Pusat Statistik Nomor 37 Tahun 2010. 2nd ed. BPS; 2010.

Moon SJ, Lee WY, Hwang JS, Hong YP, Morisky DE. Accuracy of a screening tool for medication adherence: A systematic review and meta-analysis of the Morisky Medication Adherence Scale-8. PLoS One. 2017;12(11):1–18.

Low CT, Lai PC, Tse WSC, Tsui CK, Lee H, Hui PK. Exploring tuberculosis by types of housing development. Soc Sci Med. 2013;87:77–83.

Amare H, Gelaw A, Anagaw B, Gelaw B. Smear positive pulmonary tuberculosis among diabetic patients at the Dessie referral hospital , Northeast Ethiopia. 2013;2–9.

Rajan J V., Ferrazoli L, Waldman EA, Simonsen V, Ferreira P, Telles MA, et al. Diabetes increases the risk of recent-Transmission tuberculosis in household contacts in São Paulo, Brazil. Int J Tuberc Lung Dis. 2017;21(8):916–21.

Shivakumar SVBY, Chandrasekaran P, Kumar AMV, Paradkar M, Dhanasekaran K, Suryavarshini N, et al. Diabetes and pre-diabetes among household contacts of tuberculosis patients in India: Is it time to screen them all? Int J Tuberc Lung Dis. 2018;22(6):686–94.

Ahmed N, Hasnain SE. Molecular epidemiology of tuberculosis in India : Moving forward with a systems biology approach. Tuberculosis. 2011;91(5):407–13.

Laurentia Mihardja, Dina Bisara Lolong LG. The Prevalence of Diabetes Mellitus in Tuberculosis and the Treatment Problems. J Ekol Kesehat Vol 14 No 4, Desember 2015 350-358 Tuberc. 2015;14(4):350–8.

Dewi DPR, Putra IWGAE, Sawitri AAS, Duarsa DP. Risk factors of pulmonary tuberculosis among diabetes mellitus patients in Denpasar City. Public Heal Prev Med Arch. 2017;5(1):19.

Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus : convergence of two epidemics. Lancet Infect Dis. 2009;9(12):737–46.

Ahmed M, Omer I, Osman SMA, Abakur EHA. Association between Pulmonary Tuberculosis and Type 2 Diabetes in Sudanese Patients. J Mycobacteriology. 2017;97–101.

Singh SP, Singh SP, Kishan J, Kaur S, Ramana S. Association of tuberculosis and diabetes Mellitus: An analysis of 1000 consecutively admitted cases in a tertiary care hospital of North India. Pan Afr Med J. 2016;24:1–5.

Adisa R, Olajide OO, Fakeye TO. Social Support, Treatment Adherence and Outcome among Hypertensive and Type 2 Diabetes Patients in Ambulatory Care Settings in southwestern Nigeria. Ghana Med J. 2017;51(2):64–77.

Wu Z, Guo J, Huang Y, Cai E, Zhang X, Pan Q, et al. Diabetes mellitus in patients with pulmonary tuberculosis in an aging population in Shanghai, China: Prevalence, clinical characteristics and outcomes. J Diabetes Complications. 2016;30(2):237–41.

Abera A, Ameya G. Pulmonary Tuberculosis and Associated Factors Among Diabetic Patients Attending Hawassa Adare Hospital, Southern Ethiopia. Open Microbiol J. 2018;12(1):333–42.

Syed Suleiman SA, Ishaq Aweis DM, Mohamed AJ, Razakmuttalif A, Moussa MAA. Role of diabetes in the prognosis and therapeutic outcome of tuberculosis. Int J Endocrinol. 2012;2012.

Kundu D, Roy A, Mandal T, Bandyopadhyay U, Ghosh E, Ray D. Relation of microalbuminuria to glycosylated hemoglobin and duration of type 2 diabetes. Niger J Clin Pract. 2013;16(2):216–20.

Scardina GA, Citarrella R, Messina P. Diabetic microagiopathy of oral mucosa depends on disease duration and therapy. Med Sci Monit. 2017;23:5613–9.

How to Cite
Arulita Ika Fibriana, Azam, M., Maryuni, S., Indrawati, F., Windraswara, R., & Turnbull, N. (2020). RISK FACTORS OF PULMONARY TUBERCULOSIS AMONG DIABETES MELLITUS PATIENTS: A CASE-CONTROL STUDY IN DR. KARIADI GENERAL HOSPITAL, SEMARANG, INDONESIA. Malaysian Journal of Public Health Medicine, 20(2), 101-107. https://doi.org/10.37268/mjphm/vol.20/no.2/art.307