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Role of HbA1c in TB Symptom Severity, Treatment Success, and Risk Management

At baseline, 40% of participants had euglycemic HbA1c levels, 35% had prediabetes, and 24% had diabetes, with improvements observed after three months of TB treatment. Persistent hyperglycemia was associated with a non-significant increase in unfavorable outcomes, but transient hyperglycemia doubled the risk (aIRR: 2.07; 95% CI: 1.04-4.15; P = 0.040). Patients with hyperglycemia who received diabetes treatment achieved better clinical outcomes, emphasizing the importance of timely intervention. Monitoring HbA1c trajectories during early TB treatment can help identify individuals at higher risk for unfavorable outcomes.[1] Data from three teaching hospitals in Taiwan (2005–2010) analyzed 1,473 culture-positive pulmonary TB patients (705 with diabetes, 768 without), excluding those with transient hyperglycemia at the start of treatment. Diabetic patients were less likely to achieve treatment success and faced higher risks of death and being lost-to-follow-up, with symptoms such as cough
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The cause-effect relation of TB on incidence of DM [TB0121]

1. TB and Blood Glucose Regulation Impaired blood glucose tolerance can be normalized after the successful treatment of tuberculosis (TB), but it likely persists as a risk factor for developing type 2 diabetes mellitus (T2DM) in the future. The incidence of hyperglycemia in TB patients is attributed to stress, prolonged inflammation, changes in glucose and lipid metabolism, and insulin resistance (IR) syndrome. Active TB induces various immunometabolic changes, including increased inflammation, adipose tissue modulation, and elevated free fatty acid levels, leading to IR and potentially T2DM if not clinically managed. The prevalence of hyperglycemia in TB patients varies between 10% and 26%, depending on factors such as age, sex, and fasting blood glucose levels. 2. Lipid Metabolism and Insulin Resistance TB infection causes dysregulation of lipid metabolism, increasing circulating free fatty acid levels. This leads to ectopic lipid deposition in organs critical for glucose homeostasis
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Diabetes-Associated Susceptibility to Tuberculosis [TB0120]

Diabetes and TB Risk: It is unclear whether diabetes increases the risk of active TB more significantly in overweight/obese individuals than in those who are underweight or have low BMI, especially in Asian populations where T2D develops at lower BMI levels. The distinction between newly diagnosed T2D requiring clinical management and transient stress hyperglycemia during TB treatment is critical. TB and Diabetes Development: While a history of TB is associated with a higher risk of developing T2D, the causal relationship remains inconclusive. Cholesterol and TB: Elevated cholesterol may have a protective role against TB. A large South Korean study found that low total cholesterol levels were associated with a higher TB risk, though this relationship weakened in individuals with T2D, obesity, or statin use. Active TB patients typically have lower cholesterol levels due to disease-related wasting. However, higher cholesterol among TB patients correlates with reduced disease severity, wi
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TB in older adults in the Western Pacific Region [TB0119]

The Western Pacific Region, with 1.9 billion people across 37 countries, has one of the world’s largest and fastest-growing older populations, boasting an average life expectancy of 77.7 years in 2019, above the global average. This diverse region varies in population structure, cultural norms, economic resources, and healthcare systems, leading to differences in tuberculosis (TB) transmission risk. TB Transmission Dynamics : Both reactivation and reinfection pathways contribute to TB burden, especially in high-risk settings like households, aged-care facilities, and hospitals. Institutional transmission among residents and staff in care and health facilities poses significant infection control challenges, particularly with delayed disease detection. Vulnerability of Older Adults : Ageing, diabetes, and undernutrition weaken immunity, increasing susceptibility to TB, including drug-resistant strains. Older adults living with HIV face similar risks due to age-related comorbidities. Diag
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Community-based active case finding for tuberculosis [TB0118]

Despite advancements in TB diagnostics, approximately 4 million patients—nearly 40%—remain undiagnosed or unreported globally. The majority of these individuals reside in periurban informal settlements in large cities across Africa and Asia. Detecting and treating these "missing" patients is critical for TB control, as they act as potential reservoirs for the transmission of drug-sensitive and drug-resistant strains of Mycobacterium tuberculosis . Modeling studies suggest that reducing TB transmission, disease burden, and mortality requires community-based active case finding (ACF) —where healthcare workers proactively seek, identify, and test patients for TB in the community—rather than passive case finding , which relies on patients self-presenting at healthcare facilities. Passive case finding typically identifies cases only after significant transmission has already occurred. Several ACF approaches are used in high-prevalence settings, including: Targeted screening of hig
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Risk factors of TB in Indonesia using data from IFLS-5 [TB0117]

In this study, stress was measured using responses to the survey question: “My job involves a lot of stress,” with four levels of agreement available. For analysis, responses were categorized as “High” for the two highest stress levels and “Low” for the two lowest. TB diagnosis status was based on the question: “Has a doctor/paramedic/nurse/midwife ever told you that you had TB?” Due to TB’s non-specific symptoms, misdiagnoses may have occurred, particularly where bacteriological confirmation was lacking. Additionally, some cases of TB may have remained undiagnosed, possibly due to latent infection (which is asymptomatic) or limited access to diagnostic healthcare. Among the 34,249 respondents, 328 reported having been diagnosed with TB. The study found several variables to be nonsignificant in relation to TB diagnosis status based on chi-squared and ANOVA tests. These included daily cigarette consumption, education level, food consumption satisfaction, knowledge of health facility loc
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Tuberculosis in Spain [TB0116]

·   2021 TB Cases in Spain Total reported cases: 3,754 (151 were imported). Non-imported cases: 3,603, with a notification rate (NR) of 7.61 per 100,000. Decline in cases: 2.18% decrease compared to 2020 (3,686 cases, NR = 7.78). 28.07% decrease compared to 2015 (4,913 cases, NR = 10.59). Spain classified as low-incidence for TB. ·   TB Control and Prevention Goals (Achieved in 2020) Goal 1: Reduce overall TB rate by 15%-21% from 2015 levels. Achieved reduction: 26.5%. Goal 2: Reduce annual pulmonary TB rate by 4% (2015-2020). Achieved reduction: 6%. ·   Regions with Highest and Lowest TB Notification Rates (2021) Highest NR: Ceuta, Galicia, Catalonia, Rioja, and the Basque Country. Lowest NR: Canary Islands, Castilla La Mancha, Extremadura, and Navarre. ·   Demographics and Mortality Higher incidence in men than women (rate ratio 1.7). TB incidence similar across ages 25
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DM among patients with TB in South Korea [TB0115]

·   Diabetes Prevalence in Korea : Increased from 7.6% in 2001 to 13.8% in 2018. Among tuberculosis (TB) patients, diabetes prevalence reported as 17.4%–38.9% in multiple studies. ·   TB and Diabetes (DM) Cohort Data : Korean Tuberculosis and Post-Tuberculosis cohort (TB-POST) created by linking three databases: Korean National Tuberculosis Surveillance System (KNTSS) National Health Information Database (NHID) Statistics Korea data on causes of death Purpose: To explore TB patient outcomes from 2011 to 2018. ·   Prevalence of Diabetes (DM) Among TB Patients : Nationwide prevalence among adult TB patients was 26.8%. New-onset diabetes (nDM) post-TB diagnosis significant in approximately 12.5% of these patients. DM prevalence in TB patients increased with age, highest among men aged 65–74 years (42.1%). Men were more likely to have both TB and DM than women. Age-standardized TB-DM p
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TB treatment challenges in TB-diabetes comorbid patients [TB0114]

Diabetes mellitus (DM) negatively influenced tuberculosis (TB) treatment outcomes. Patients with TB without DM (TB-non-DM) had a lower risk of extended treatment duration and TB recurrence compared to those with TB and DM comorbidity (TB-DM).  The meta-analysis indicated a significantly lower risk of extended treatment duration in TB-non-DM patients compared to TB-DM patients (HR = 0.72, 95% CI: 0.56–0.83, p = .01), with moderate heterogeneity across studies (I² = 59%). Source: Khattak M, et al. (2024). Tuberculosis (TB) treatment challenges in TB-diabetes comorbid patients: a systematic review and meta-analysis, Annals of Medicine, 56:1, 2313683. https://doi.org/10.1080/07853890.2024.2313683  
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Risk of Herpes Zoster in Patients with Pulmonary TB [TB0113]

The cumulative incidence of herpes zoster (HZ) was significantly higher in patients with pulmonary tuberculosis (TB) compared to those without TB. Patients with TB had an increased risk of developing HZ, with crude and adjusted hazard ratios (cHR and aHR) of 1.20 and 1.23, respectively. This risk was further elevated in TB patients with comorbidities like diabetes mellitus (DM), chronic kidney disease (CKD), coronary artery disease (CAD), and cancer, with an adjusted hazard ratio (aHR) of 1.16. Even in the absence of comorbidities, TB patients were 1.28 times more likely to develop HZ than non-TB patients, suggesting that TB may act as a stressor for HZ onset. The data source did not include smoking data, though smoking is a known risk factor for TB. Effective treatment for TB is essential to reduce the potential risk of HZ. Source: Wang C-A, Chen C-H, Hsieh W-C, Hsu T-J, Hsu C-Y, Cheng Y-C, Hsu C-Y. Risk of Herpes Zoster in Patients with Pulmonary Tuberculosis—A Population-Based Cohor
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