The effect of type 2 DM on the presentation and treatment response of pulmonary TB

Alisjahbana, B., Sahiratmadja, E., Nelwan, E.J., Purwa, A.M., Ahmad, Y., Ottenhoff, T.H., Nelwan, R.H., Parwati, I., Meer, J.W.V.D. and Crevel, R.V., 2007. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clinical infectious diseases, 45(4), pp.428-435.

  • Historical Context and Re-Emergence: Diabetes mellitus (DM) was historically known as a risk factor for tuberculosis (TB) but gained less attention in the latter half of the 20th century with advancements in treatment. However, with the recent global increase in type 2 DM, the association between DM and TB has resurfaced, impacting 10%–30% of TB patients.
  • Epidemiological Data from Indonesia: Indonesia is ranked third worldwide for TB incidence and fourth for DM prevalence. Recent studies have highlighted the significant linkage between DM and TB within this demographic.
  • Impact of Insulin on TB Outcomes: Before the introduction of insulin in 1922, DM patients frequently succumbed to pulmonary TB. Although TB continues to pose a threat, the prognosis for DM patients has markedly improved with the advent of effective TB treatments.
  • Clinical Observations in Indonesia: A notable proportion of TB patients in Indonesia are diagnosed with type 2 DM. These patients present with more symptoms but without increased severity on TB diagnostic tests, suggesting a complex interaction rather than direct exacerbation by DM.
  • Treatment Dynamics and Outcomes: Diabetic patients with TB tend to adhere better to treatment protocols and show lower drug resistance rates. However, DM complicates the treatment outcome, evidenced by higher positive sputum culture rates after six months, even when accounting for other variables.
  • Recommendations for Dual Screening: Given the intertwined complications and symptoms of both diseases, it is recommended to screen all TB patients for DM, especially those over 35, to optimize management and improve treatment outcomes.

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