Paper Title
Diabetic Status and the Risk of Tuberculosis: A Nationwide Population-based Study

Abstract
Objective: To evaluate the impact of diabetic mellitus (DM) status and duration on the incidence of tuberculosis (TB) in general population. Methods: We identified 6,312,283 subjects who are free of TB until one year after the day of their health examination (2009) and were followed up until December 31, 2018 using the database of the Korean National Health Insurance Service. Cox proportional hazard regression was used to assess adjusted hazard ratios (aHR) of DM status and duration for TB with adjustment for potential confounders. Results: A total of 30,917 individuals were diagnosed with TB during the follow-up period. An increased risk of TB incidence was observed in DM subjects compared to non-DM subjects (aHR 1.49, 95% confidence interval [CI] 1.45-1.53). While subjects with impaired fasting glucose showed a decreased risk of TB incidence (aHR 0.96, 95% CI 0.93-0.98), the risk of TB incidence was increased with duration of DM (aHR 1.32, 95% CI 1.25-1.40 in the new-onset DM; aHR 1.46, 95% CI 1.39-1.53 in the DM with duration < 5 years; aHR 1.54, 95% CI 1.48-1.60 in the DM with duration ≥ 5 years). Among non-DM subjects, a U-shaped association was noted between fasting glucose concentrations and the risk of TB. Conclusion: DM status was an independent predictor for developing TB with a dose-response relationship.In non-DM subjects, there was a U-shaped association between fasting glucose concentrations and TB risk,suggestive of protective role of BMI on TB in non-DM subjects. Keywords - Fasting glucose, Impaired fasting glucose, Diabetes, Tuberculosis