Determinan Kejadian Tuberkulosis Paru pada Penderita Diabetes Melitus Tipe 2 di Kota Medan

Abstract

Tuberculosis (TB) remains a global health challenge, particularly among populations with comorbidities such as Type 2 Diabetes Mellitus (T2DM). Individuals with diabetes are at a higher risk of developing pulmonary TB due to impaired immune function. This study aimed to analyze the determinants of pulmonary TB incidence among T2DM patients in Medan City. A non-matched case-control study design was used, involving a total of 128 participants, consisting of 64 cases (T2DM with TB) and 64 controls (T2DM without TB), selected through purposive sampling from 10 primary health centers (Puskesmas) in Medan. The independent variables included age, sex, diabetes medication adherence, duration of diabetes, smoking habits, family history of diabetes, history of contact with active TB patients, and Body Mass Index (BMI). Data were analyzed using univariate, bivariate (Chi-square and simple logistic regression), and multivariate analyses (multiple logistic regression with enter method). The multivariate analysis revealed five variables that significantly influenced the incidence of pulmonary TB among T2DM patients: sex (OR = 7,058; p = <0,001; 95% CI = 2,553-19,511), diabetes medication adherence (OR = 3,446; p = 0,017; 95% CI = 1,252-9,596), duration of diabetes (OR = 0,120; p = 0,001; 95% CI = 0,035 – 0,410), history of contact with TB patients (OR = 9,504; p = 0,002; 95% CI= 2,276-39,676), underweight BMI (OR = 13,908; p = 0,040, 95% CI= 1,128-171,437). These findings suggest that, beyond metabolic dysfunction, behavioral and environmental factors substantially contribute to TB risk among diabetics. In conclusion, TB prevention strategies in T2DM patients should be comprehensive and risk-based. It is recommended to integrate TB-DM control programs at the primary care level, conduct regular nutritional and contact screening, promote smoking cessation, and consider TB preventive therapy (TPT) for high-risk diabetic individuals