Effect of diabetes on tuberculosis control in 13 countries with high tuberculosis

Patients with Type 2 Diabetes Mellitus (T2DM) and Pulmonary Tuberculosis (PTB) are more likely to experience poor glycemic control, increased frequency of infections, and a higher prevalence of smoking, alcohol consumption, and lack of physical activity. Independent risk factors for concurrent T2DM and PTB include lymphopenia, smoking, a history of TB exposure, and poor glycemic control. Conversely, being overweight or obese is associated with a reduced risk of concurrent PTB in patients with T2DM.

Shi H, Yuan Y, Li X, Li YF, Fan L, Yang XM. Analysis of the influencing factors and clinical related characteristics of pulmonary tuberculosis in patients with type 2 diabetes mellitus. World J Diabetes 2024; 15(2): 196-208.

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Pan, S.C., Ku, C.C., Kao, D., Ezzati, M., Fang, C.T. and Lin, H.H., 2015. Effect of diabetes on tuberculosis control in 13 countries with high tuberculosis: a modelling study. The lancet Diabetes & endocrinology, 3(5), pp.323-330.

  • Diabetes is recognized as a significant risk factor in the global post-2015 tuberculosis strategy, yet effective collaboration between tuberculosis and diabetes programs is lacking in most countries.
  • Thirteen countries, namely Afghanistan, Bangladesh, Brazil, Cambodia, China, India, Indonesia, Myanmar, Pakistan, Philippines, Russian Federation, Thailand, and Vietnam, account for 60% of the world's new tuberculosis cases.
  • Stabilizing diabetes prevalence at 2015 levels in these countries could accelerate the reduction of tuberculosis incidence by 20.3% and mortality by 42.7% by 2035, potentially preventing 1.1 million tuberculosis deaths over 20 years.
  • The impact of reducing diabetes prevalence on tuberculosis is highly sensitive to factors such as the relative risks for relapse and progression in diabetic patients, transmission rates, partial immunity, and tuberculosis-specific mortality.
  • Diabetes alone significantly influences the trajectory of tuberculosis morbidity and mortality in these high-burden countries over the next 20 years.
  • Preventing diabetes offers a chance to hasten the decrease in tuberculosis incidence and mortality in the countries with the highest burdens.
  • While being overweight and obese lowers the risk of tuberculosis, it increases the risk of diabetes. Rising diabetes prevalence paired with increased BMI might counteract the adverse effects of diabetes on tuberculosis.
  • There is a need for the communicable and non-communicable disease sectors to transcend traditional boundaries and collaborate to formulate integrated national health policies addressing both diabetes and tuberculosis.
  • Suggested measures include bidirectional screening for diabetes and tuberculosis at primary healthcare centers and adapting the DOTS (Directly Observed Treatment, Short-course) framework for non-communicable disease management in resource-limited settings.

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