The effect of diabetic control status on the clinical features of pulmonary TB

Park, S.W., Shin, J.W., Kim, J.Y., Park, I.W., Choi, B.W., Choi, J.C. and Kim, Y.S., 2012. The effect of diabetic control status on the clinical features of pulmonary tuberculosis. European journal of clinical microbiology & infectious diseases, 31, pp.1305-1310.

  • TB patients with diabetes (DM) were older, predominantly male, and had more comorbidities like hypertension and cardiovascular disease compared to those without DM.
  • No differences in symptoms, radiographic findings, or AFB positivity on sputum smear tests between controlled diabetics and non-diabetics.
  • Diabetic TB patients had more cavities, especially in uncontrolled diabetics, but no differences in the number of involved lobes or location of involvement.
  • Higher AFB positivity on sputum smear in TB patients with DM (59.5%) vs. without DM (40.4%), with uncontrolled diabetics showing an even higher rate (65.8%).
  • Uncontrolled diabetes was linked to more cavities and higher rates of positive culture conversion at two months.
  • Treatment duration was longer in uncontrolled diabetics (7 months) compared to non-diabetics (6 months).
  • Diabetics, especially uncontrolled, had higher rates of positive sputum smears and cavitary lesions.
  • Diabetics are more susceptible to TB due to impaired immune response mechanisms.

    • Abstract:

    The aim of this study was to determine whether the control status of diabetes mellitus influences clinical and radiographic manifestations and treatment responses in patients with tuberculosis (TB). The medical records of 492 patients who started anti-TB medication between January 2005 and December 2009 were retrospectively reviewed. Diabetes was diagnosed in 124 patients (25.2%). Of these, 74 (59.7%) were uncontrolled (HbA1C ≥7.0), 25 (20.2%) were controlled (HbA1C <7.0), and HbA1C levels were not assessed in the remaining 25 (20.2%). There were no differences in clinical symptoms between diabetics and non-diabetics, regardless of diabetes control status. There were also no differences in radiographic findings or AFB results between controlled diabetics and non-diabetics. However, uncontrolled diabetics had more cavitary lesions (p=0.008) and higher positive smear rates (p<0.001) compared to non-diabetics. After adjustment for age, cavities, and positive smears before the initiation of treatment, uncontrolled diabetes was a significant risk factor for a positive sputum culture at 2 months (odds ratio, 4.316; 95% CI, 1.306–14.267; p=0.017). Uncontrolled diabetics seem to have more cavities, higher positive smear rates, and a lack of culture conversion after two months of therapy. Therefore, TB patients with uncontrolled diabetes should be carefully managed and treated.

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