Diabetes and risk of tuberculosis relapse

A retrospective cohort study in Lianyungang, China, examined the impact of diabetes mellitus (DM) on pulmonary tuberculosis (TB) recurrence. Researchers analyzed 12,509 newly diagnosed TB cases from 2011 to 2019, with a median follow-up of 5.46 years. Using Cox proportional hazard models, they assessed treatment outcomes, recurrence rates, and risk factors. The study identified DM as a significant independent variable affecting TB recurrence while accounting for confounding factors such as age, gender, and drug resistance.[1] See also: https://tbreadingnotes.blogspot.com/2024/07/modelling-effect-of-discontinuing.html

The results showed that TB recurrence rates were significantly higher among DM patients (20.21 per 1000 person-years) compared to non-DM patients (6.28 per 1000 person-years). Males with DM had the highest recurrence rate at 26.22 per 1000 person-years. The median time to recurrence was 1.81 years, with 72.9% of recurrences occurring within three years after treatment completion. Key risk factors included DM (HR = 2.40, P<0.001), male gender, advanced age (≥60 years), initial etiologic positivity, and drug resistance, while protective factors included student status and the use of fixed-dose combination (FDC) medications.[1]

The study concludes that DM significantly increases TB recurrence risk, with affected individuals facing a 2.5 times higher hazard than non-DM patients. Gender and age-specific analyses revealed a stronger association in males and younger individuals. The findings highlight the need for integrated TB-DM screening and close monitoring of high-risk patients to reduce recurrence and improve long-term treatment outcomes.[1]

Diabetes mellitus (DM) during anti-TB treatment is associated with a higher risk of TB relapse, though this association weakens in individuals over 60 years. In a national cohort, DM was independently linked to increased relapse risk, highlighting the need for strengthened follow-up strategies to detect recurrence early. TB programs should prioritize rigorous glucose control for DM-TB patients to improve long-term outcomes.[2]

Diabetes mellitus (DM) is increasingly recognized as a risk factor for tuberculosis (TB), though the relationship between the two remains complex. While it is unclear whether TB or its treatment directly increases the risk of developing DM, impaired glucose tolerance (IGT) is commonly observed during anti-TB therapy and may resolve after treatment. This temporary hyperglycemia could result from undiagnosed DM, a stress response to infection leading to elevated stress hormone levels, or TB-induced pancreatic dysfunction. Blood glucose testing during TB treatment varies across studies, with Fasting Blood Glucose (FBG) being the most commonly used method, followed by the Oral Glucose Tolerance Test (OGTT) and HbA1c. Standardizing glucose screening during TB treatment is crucial, as some studies only monitored patients with initially high glucose levels, potentially overlooking new cases of DM.[3]

Trends in blood glucose levels indicate that many TB patients with initially high readings experience a decline in glucose levels during treatment, likely due to reduced stress hormone activity. However, some patients develop persistent hyperglycemia, which may stem from undiagnosed pre-existing DM or IGT that progresses due to infection-induced insulin resistance. Additionally, severe TB cases, particularly those with cavitary lung lesions, are linked to higher blood glucose levels, reinforcing the importance of glucose monitoring. Despite these challenges, effective TB treatment and adequate glucose control can lead to favorable outcomes for DM-TB patients, emphasizing the need for integrated care strategies.[3]

Diabetic TB patients face higher risks of treatment failure, death, and recurrent TB compared to non-diabetic TB patients. However, those enrolled in an enhanced case management program for diabetes mellitus (DM) had a lower likelihood of developing TB, and if they did, they experienced better treatment outcomes than those not in the program. This highlights the importance of integrated DM-TB management in improving patient prognosis and reducing TB-related complications.[4]

Reference:

1. Wang, Y., Shi, J., Yin, X., Tao, B., Shi, X., Mao, X., Wen, Q., Xue, Y. and Wang, J., 2024. The impact of diabetes mellitus on tuberculosis recurrence in Eastern China: a retrospective cohort study. BMC Public Health, 24(1), p.2534.

2. Lee, P.H., Lin, H.C., Huang, A.S.E., Wei, S.H., Lai, M.S. and Lin, H.H., 2014. Diabetes and risk of tuberculosis relapse: nationwide nested case-control study. PloS one, 9(3), p.e92623.

3. Williams, V., Onwuchekwa, C., Vos, A.G., Grobbee, D.E., Otwombe, K. and Klipstein-Grobusch, K., 2022. Tuberculosis treatment and resulting abnormal blood glucose: a scoping review of studies from 1981-2021. Global Health Action, 15(1), p.2114146.

4. Lo, H.Y., Yang, S.L., Lin, H.H., Bai, K.J., Lee, J.J., Lee, T.I. and Chiang, C.Y., 2016. Does enhanced diabetes management reduce the risk and improve the outcome of tuberculosis?. The International Journal of Tuberculosis and Lung Disease, 20(3), pp.376-382.