Managing TB-Diabetes Comorbidity

• TB-diabetes co-occurrence is shaped by both biological and socio-environmental factors, including poverty, malnutrition, smoking, and poor healthcare access. Older adults and males are at heightened risk due to weakened immunity and higher TB incidence, respectively. See also: Lin TB Lab
• Diabetes increases TB risk by weakening the immune system via chronic hyperglycemia and inflammation. TB worsens glycemic control through stress-induced insulin resistance, and some TB drugs interfere with diabetes medications, complicating treatment.
• Managing TB in diabetic patients requires strict glucose monitoring and tailored medication plans. Integrated care models and preventive measures like latent TB screening are essential to improve outcomes. See also: Benang Merah RC
• Diabetic TB patients tend to be older males with more comorbidities, yet symptoms and X-rays often resemble non-diabetic cases. Poor glycemic control is tied to more severe TB presentations and longer treatment times.
• At IBIT in Brazil, 11.8% of symptomatic adults had PTB, with many showing poor nutrition, high alcohol use, and smoking. Among them, 63.1% had glucose metabolism issues and poor glycemic control significantly raised TB risk.
• In Shenzhen and Kunming, 16.8% of confirmed PTB cases also had diabetes, with these patients being older, predominantly male, and exhibiting worse metabolic health. Low education and high alcohol use were more common among the PTB-DM group.
• Risk factors for diabetes among TB patients include male sex, age, family history of diabetes, and elevated glucose levels. Heavy alcohol use increases risk, while awareness of diabetes offers significant protection.
• Diabetes is emerging as a major obstacle to TB control, especially in low- and middle-income countries, mirroring the threat level of HIV/AIDS. Despite this, research funding and large-scale clinical trials for TB-DM comorbidity remain scarce.
• A nationwide South Korean study found TB-DM patients had worse disease severity, more comorbidities, and higher death rates. TB was the leading cause of death, with male and low-income patients especially vulnerable.
• In Eastern China, diabetics had significantly higher TB incidence, especially those with lower BMI. This suggests that underweight diabetics are at particular risk, while higher BMI may offer some protection.
• Males and older individuals had higher TB rates, while BCG vaccination scars were linked to lower TB incidence. Diabetes significantly raised TB risk in lean individuals but had no effect in those with higher BMI.
• Korean national data showed diabetes raises TB risk by 48%, and long-standing diabetes (>5 years) increases this further to 57%. Younger adults and men with high fasting glucose were particularly affected.
• A Taiwan study found TB survivors face higher risks of diabetes, heart attacks, and strokes post-treatment. Longer TB treatment durations and existing chronic conditions worsen these outcomes, requiring post-TB health monitoring.

References:

1. Munir, M.A., Khan, S., Rehman, S., Ahmed, D. and Jabbar, A., 2024. Tuberculosis among diabetes patients: a review of epidemiology, pathophysiology, clinical manifestations, and management. Chronicles of Biomedical Sciences, 1(3), pp. PID26-PID26.
2. Park, S.W., Shin, J.W., Kim, J.Y., Park, I.W., Choi, B.W., Choi, J.C. and Kim, Y.S., 2012. The effect of diabetic control status on the clinical features of pulmonary tuberculosis. European journal of clinical microbiology & infectious diseases, 31, pp.1305-1310.
3. Almeida-Junior JL, Gil-Santana L, Oliveira CAM, Castro S, Cafezeiro AS, Daltro C, et al. (2016) Glucose Metabolism Disorder Is Associated with Pulmonary Tuberculosis in Individuals with Respiratory Symptoms from Brazil. PLoS ONE 11(4):e0153590.
4. Li, J., Zhao, Y., Jiang, Y., Zhang, Y., Zhang, P., Shen, L. and Chen, Z., 2024. Prevalence and risk factors of diabetes in patients with active pulmonary tuberculosis: a cross-sectional study in two financially affluent China cities. Diabetes, Metabolic Syndrome and Obesity, pp.1105-1114.
5. Bao, J., Hafner, R., Lin, Y., Lin, H.H. and Magee, M.J., 2018. Curbing the tuberculosis and diabetes co-epidemic: strategies for the integration of clinical care and research. The International Journal of Tuberculosis and Lung Disease, 22(10), pp.1111-1112.
6. Kwak SH, Jeong D, Mok J, Jeon D, Kang H-Y, Kim HJ, et al. (2023) Association between diabetes mellitus and cause of death in patients with tuberculosis: A Korean nationwide cohort study. PLoS ONE 18(12): e0295556.
7. Lu, P., Zhang, Y., Liu, Q., Ding, X., Kong, W., Zhu, L. and Lu, W., 2021. Association of BMI, diabetes, and risk of tuberculosis: a population-based prospective cohort. International Journal of Infectious Diseases, 109, pp.168-173.
8. Yoo JE, Kim D, Han K, Rhee SY, Shin DW, Lee H. Diabetes status and association with risk of tuberculosis among Korean adults. JAMA network open. 2021 Sep 1;4(9):e2126099.
9. Salindri, A.D., Wang, J.Y., Lin, H.H. and Magee, M.J., 2019. Post-tuberculosis incidence of diabetes, myocardial infarction, and stroke: retrospective cohort analysis of patients formerly treated for tuberculosis in Taiwan, 2002–2013. International Journal of Infectious Diseases, 84, pp.127-130.

TBC 056