Curbing the tuberculosis and diabetes co-epidemic

Efforts to reduce tuberculosis (TB) incidence and mortality have progressed slowly, with control strategies increasingly threatened by the rising prevalence of diabetes mellitus (DM), a non-communicable disease. DM significantly elevates the risk of developing active TB and contributes to clinical challenges, such as higher rates of treatment failure, relapse, and death. Alarmingly, the DM epidemic has grown most rapidly in low- and middle-income regions, where TB burdens are already high, making DM a contributor to active TB cases on par with HIV/AIDS. Despite this dual burden, resources for TB-DM research and treatment remain limited, and large-scale clinical trials to improve care for co-affected patients have yet to be conducted, leaving critical gaps in understanding and managing this dangerous intersection.[1]

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A retrospective nationwide cohort study in South Korea analyzed the interplay between tuberculosis (TB) and diabetes mellitus (DM) using comprehensive data sources, including the Korean National Tuberculosis Surveillance System and national health and mortality records from 2011 to 2018. The study identified DM through specific diagnostic codes or anti-diabetic prescriptions and revealed that TB patients with DM were predominantly male, older, and from lower-income groups. These patients exhibited more severe disease profiles, including higher rates of positive TB tests, greater comorbidity burdens, and elevated Charlson Comorbidity Index scores compared to those without DM. Treatment outcomes were notably worse in the DM group, with higher mortality rates and shorter median survival times. TB was the leading cause of death, accounting for 47.9% of fatalities, while non-TB-related deaths were often due to lung cancer and pneumonia. Among the DM group, diabetes itself emerged as the third leading cause of death.[2]

Further analysis underscored that DM significantly increased the risk of TB-related mortality in men but not in women, while elevating the likelihood of non-TB-related deaths across both sexes. Cumulative mortality data confirmed a higher death risk in the DM group for both genders. Factors such as advanced age, low income, positive acid-fast bacillus (AFB) smear tests, and higher comorbidity scores were consistently linked to poorer outcomes. These findings highlight the compounded vulnerabilities of TB patients with DM and underscore the need for targeted interventions to improve outcomes in this high-risk population.[2] 

References:

1. 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.

2. 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. https://doi.org/10.1371/journal.pone.0295556