Diabetes, Immune Response, and TB Susceptibility

· 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:

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.
6. Meghji, J., Kon, O.M. and Ainley, A., 2023. Clinical tuberculosis. Medicine, 51(11), pp.768-773.

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