TB and NCDs Interconnected Risks

· Older age, male gender, and traditional chronic NCDs (Non-Communicable Diseases) are predictive of the incidence of diabetes, acute myocardial infarction (AMI), and stroke post-TB treatment.

· Longer TB treatment duration (7–12 months) is associated with a higher incidence of NCDs compared to shorter treatment durations (≤6 months).

· TB diagnosis indicates an elevated risk of cardiovascular disease (CVD), necessitating cardiovascular health assessments in patients with active TB following current CVD screening guidelines.

· Diabetes significantly increases the likelihood of TB symptoms, including cough, hemoptysis, tiredness, and weight loss, with symptom severity correlating with higher HbA1C levels, particularly over 9%.

· Diabetes also increases the likelihood of maintaining a positive smear in TB patients, influenced by HbA1C levels, as well as other factors like age, sex, smoking, and drug resistance.

· Effective glycemic control is crucial in improving TB treatment outcomes and reducing the risk of TB transmission in diabetic patients.

· DM (Diabetes Mellitus) significantly increases the risk of developing active TB and is associated with worse clinical outcomes, including higher risks of treatment failure, relapse, and death.

· The rising prevalence of DM in low- and middle-income regions with significant TB burdens exacerbates TB outcomes, necessitating targeted healthcare strategies.

· Systematic screening for active TB is recommended, particularly in populations with specific risk factors like history of TB, HIV, self-reported diabetes, and current smoking.

· Males, despite being more likely to have TB, are underrepresented in screenings, highlighting a need for more inclusive screening strategies.

· Current smoking and self-reported diabetes increase the risk of TB by approximately 1.5-fold, with smokers more likely to have subclinical TB and diabetic patients more likely to have symptomatic TB.

· TB programs should consider prioritizing smokers for chest X-ray screening alongside symptom screening to better identify and treat subclinical TB cases, particularly in high-risk populations.

Reference:

1.    Salindri, A.D., Wang, J.Y., Lin, H.H. and Magee, M.J., 2019. Post-tuberculosis incidence of diabetes, myocardial infarction, and stroke: retrospective cohort analysis of patients formerly treated for tuberculosis in Taiwan, 2002–2013. International Journal of Infectious Diseases, 84, pp.127-130.

2.    Basham CA, Smith SJ, Romanowski K, Johnston JC (2020). Cardiovascular morbidity and mortality among persons diagnosed with tuberculosis: A systematic review and meta-analysis. PLoS ONE, 15(7), e0235821.

3.    Chiang CY, Bai KJ, Lin HH, Chien ST, Lee JJ, Enarson DA, et al. (2015) The Influence of Diabetes, Glycemic Control, and Diabetes-Related Comorbidities on Pulmonary Tuberculosis. PLoS ONE 10(3): e0121698.

4.    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.

5.     Hamada, Y., Quartagno, M., Law, I., Malik, F., Bonsu, F.A., Adetifa, I.M., Adusi-Poku, Y., D'Alessandro, U., Bashorun, A.O., Begum, V. and Lolong, D.B., 2023. Association of diabetes, smoking, and alcohol use with subclinical-to-symptomatic spectrum of tuberculosis in 16 countries: an individual participant data meta-analysis of national tuberculosis prevalence surveys. EClinicalMedicine, 63.

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