· Diabetes Increases TB Risk
- DM is associated with a higher TB risk (HR: 1.90, OR: 1.61, RR: 1.60).
- Risk of TB recurrence is also elevated (HR: 1.35).
- The highest risk occurs within the first 10 years of DM diagnosis.
- Reducing diabetes burden is crucial for TB elimination. See also: Lin TB Lab
· Complexity of DM2-TB Relationship
- Factors like age, glucose control, and healthcare access affect TB risk in DM2 patients.
- Military personnel with DM2 have higher TB recurrence rates, but findings were not statistically significant.
- Contextual factors (e.g., healthcare resources, environmental exposure) play a major role. See also: Scholarships Info
· Immune Interactions in Prediabetes & TB
- Prediabetes alters immune responses, influencing TB susceptibility.
- Unique cytokine patterns (e.g., IL-27 ↑, IL-38 ↓, IL-17 ↑, IL-9 ↓) affect M. tb clearance.
- Insulin resistance-related inflammation may both protect against and worsen TB risk.
- Chronic diabetes further suppresses TB immunity, raising concerns about LTBI detection accuracy.
· Global & Regional TB Trends
- 30 high-burden countries account for 87% of TB cases, with India, Indonesia, and China leading.
- TB incidence in England is low (7.3/100,000), but disparities exist (foreign-born cases: 36.3/100,000).
- WHO’s ‘End TB’ strategy promotes new diagnostics and all-oral MDR/RR-TB regimens.
· Public-Private Mix (PPM) & TB Control in Pakistan
- PPM models improve TB detection & treatment success (90.6% success rate).
- NGOs perform best (94.9% success), while parastatal facilities perform worst (46.7%).
- Strengthening PPM can enhance TB control efforts.
· Diabetes & TB Comorbidity Debate
- Some studies unexpectedly found no statistical link between DM and TB.
- Rising DM prevalence, especially in low- and middle-income countries, poses a challenge to TB control.
- Integrated strategies are needed to tackle both diseases effectively.
References:
- Franco, J.V., Bongaerts, B., Metzendorf, M.I., Risso, A., Guo, Y., Silva, L.P., Boeckmann, M., Schlesinger, S., Damen, J.A., Richter, B. and Baddeley, A., 2024. Diabetes as a risk factor for tuberculosis disease. The Cochrane database of systematic reviews, 8, p.CD016013.
- Alvarado-Valdivia, N.T., Flores, J.A., Inolopú, J.L. and Rosales-Rimache, J.A., 2024. Type 2 diabetes mellitus and recurrent Tuberculosis: A retrospective cohort in Peruvian military workers. Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, 35, p.100432.
- Aravindhan, V. and Yuvaraj, S., 2024. Immune-endocrine network in diabetes-tuberculosis nexus: does latent tuberculosis infection confer protection against meta-inflammation and insulin resistance?. Frontiers in Endocrinology, 15, p.1303338.
- Ullah, W., Wali, A., Haq, M.U., Yaqoob, A., Fatima, R. and Khan, G.M., 2021. Public–private mix models of tuberculosis care in Pakistan: a high-burden country perspective. Frontiers in public health, 9, p.703631.
- Khalid N, Ahmad F, Qureshi FM. Association amid the comorbidity of Diabetes Mellitus in patients of Active Tuberculosis in Pakistan: A matched case control study. Pak J Med Sci. 2021;37(3):816-820.
- Meghji, J., Kon, O.M. and Ainley, A., 2023. Clinical tuberculosis. Medicine, 51(11), pp.768-773.
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