Integrated Disease Management

1. Diabetes and TB Risk & Progression

• Diabetes mellitus (DM) increases the risk of active TB, poor treatment outcomes, and higher relapse rates.
• Prediabetes (PDM) also raises TB susceptibility due to chronic low-grade inflammation and immune dysfunction.
• Even mild glucose imbalances can impair immunity, increasing TB risk, especially in high-burden regions.
• TB can induce temporary hyperglycemia, sometimes unmasking undiagnosed diabetes or worsening metabolic dysfunction.

2. Immune System Interactions & Inflammatory Response

• Chronic inflammation in DM and PDM alters immune responses, making individuals more prone to TB.
• Studies show mixed immune profiles in TB patients with PDM—some indicating heightened inflammation, others showing suppressed immunity.
• Mycobacterium tuberculosis infections in hyperglycemic states can further weaken immune defenses, promoting TB progression.
• Obesity appears to lower TB risk, potentially due to immune modulation, though the mechanisms remain unclear.

3. Public Health & Integrated Disease Management

• Screening for TB in diabetic patients and glucose monitoring in TB patients should be routine.
• TB patients with DM have worse treatment outcomes, including multidrug-resistant TB and lower survival rates.
• Integrated care models addressing both TB and DM can improve patient outcomes and support TB control efforts.
• Countries like Korea, with declining TB rates, face new challenges with aging populations, requiring targeted interventions.

References:

1. Abbas, U., Masood, K.I., Khan, A., Irfan, M., Saifullah, N., Jamil, B. and Hasan, Z., 2022. Tuberculosis and diabetes mellitus: Relating immune impact of co-morbidity with challenges in disease management in high burden countries. Journal of clinical tuberculosis and other mycobacterial diseases, 29, p.100343.
2. Byers, M.; Guy, E. The Complex Relationship Between Tuberculosis and Hyperglycemia. Diagnostics 2024, 14, 2539.
3. Lee P-H, Fu H, Lai T-C, Chiang C-Y, Chan C-C, Lin H-H (2016) Glycemic Control and the Risk of Tuberculosis: A Cohort Study. PLoS Med 13(8): e1002072.
4. Lee, P.H., Fu, H., Lee, M.R., Magee, M. and Lin, H.H., 2018. Tuberculosis and diabetes in low and moderate tuberculosis incidence countries. The International Journal of Tuberculosis and Lung Disease, 22(1), pp.7-16.
5. Salindri, A.D., Haw, J.S., Amere, G.A., Alese, J.T., Umpierrez, G.E. and Magee, M.J., 2021. Latent tuberculosis infection among patients with and without type-2 diabetes mellitus: results from a hospital case-control study in Atlanta. BMC Research Notes, 14(1), p.252.
6. Barron, M.M., Shaw, K.M., Bullard, K.M., Ali, M.K. and Magee, M.J., 2018. Diabetes is associated with increased prevalence of latent tuberculosis infection: Findings from the National Health and Nutrition Examination Survey, 2011–2012. Diabetes research and clinical practice, 139, pp.366-379.
7. Kang, Y.A., Kim, S.Y., Jo, K.W., Kim, H.J., Park, S.K., Kim, T.H., Kim, E.K., Lee, K.M., Lee, S.S., Park, J.S. and Koh, W.J., 2014. Impact of diabetes on treatment outcomes and long-term survival in multidrug-resistant tuberculosis. Respiration, 86(6), pp.472-478.
8. Jeong D, et al. Prevalence and associated factors of diabetes mellitus among patients with tuberculosis in South Korea from 2011 to 2018: a nationwide cohort study. BMJ Open 2023;13:e069642.
9. Min, J., Jeong, Y., Kim, H.W. and Kim, J.S., 2024. Tuberculosis notification and incidence: Republic of Korea, 2022. Tuberculosis and Respiratory Diseases, 87(3), p.411.

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