Glucose metabolism disorder is associated with pulmonary TB

The co-occurrence of TB and diabetes is influenced by biological and socio-environmental factors, including poverty, malnutrition, smoking, alcohol use, and limited healthcare access. Age and gender also play a role, with older adults at higher risk due to weakened immunity, and males generally having a higher TB incidence.[1] See also: https://tbreadingnotes.blogspot.com/2024/09/burden-of-drug-susceptible-tuberculosis.html

Diabetes increases TB susceptibility through immune dysfunction caused by chronic hyperglycemia, impaired macrophage activity, and systemic inflammation. TB, in turn, worsens glycemic control by inducing stress hormones and insulin resistance. Antitubercular drugs, especially rifampicin, can interfere with diabetes medications, making treatment management complex.[1] See also: https://tbreadingnotes.blogspot.com/2024/07/effect-of-diabetes-on-tuberculosis.html

Effective management of TB in diabetic patients requires close monitoring of blood glucose levels, adjustments in diabetes medications, and adherence support. Preventive strategies include latent TB screening, lifestyle modifications, and integrated healthcare models that combine TB and diabetes care to improve patient outcomes.[1]

TB patients with diabetes (DM) are generally older, more often male, and have higher rates of comorbidities like hypertension and cardiovascular disease, yet their symptoms and radiographic findings are similar to non-diabetics. However, uncontrolled diabetes is linked to a higher prevalence of acid-fast bacilli (AFB) positivity, more cavitary lesions, and prolonged treatment duration due to impaired immune responses caused by chronic hyperglycemia. TB further exacerbates diabetes by inducing insulin resistance through systemic inflammation and stress hormones, making glycemic control more difficult and prolonging recovery. Managing these coexisting conditions requires integrated care, including strict blood sugar monitoring, screening for latent TB in diabetics, and tailored treatment strategies to mitigate drug interactions and disease severity.[2]

A study at the Instituto Brasileiro para a Investigação da Tuberculose (IBIT) in Salvador, Bahia, examined 892 adults with respiratory symptoms, finding a pulmonary tuberculosis (PTB) prevalence of 11.8%, with patients more often male, younger, and having lower BMIs, chronic alcoholism, and symptoms like fever, night sweats, and weight loss. Lifestyle factors such as smoking (42.4%) and chronic alcoholism (4.6%) were common, alongside comorbidities like COPD, HIV/AIDS, pulmonary silicosis, and cancer. Diabetes mellitus (DM) played a significant role, with 9% having a prior diagnosis and 63.1% exhibiting glucose metabolism disorders (GMD), while 80% of PTB cases had elevated HbA1c at diagnosis. Poor glycemic control (HbA1c ≥7.0%) greatly increased TB risk, and newly diagnosed diabetics had higher Acid-Fast Bacilli (AFB) positivity, with regression analyses confirming uncontrolled DM and smoking as major risk factors, increasing TB susceptibility by over six times.[3]

References:

1. Munir, M.A., Khan, S., Rehman, S., Ahmed, D. and Jabbar, A., 2024. Tuberculosis among diabetes patients: a review of epidemiology, pathophysiology, clinical manifestations, and management. Chronicles of Biomedical Sciences, 1(3), pp.PID26-PID26.

2. 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.

3. Almeida-Junior JL, Gil-Santana L, Oliveira CAM, Castro S, Cafezeiro AS, Daltro C, et al. (2016) Glucose Metabolism Disorder Is Associated with Pulmonary Tuberculosis in Individuals with Respiratory Symptoms from Brazil. PLoS ONE 11(4):e0153590. doi:10.1371/journal.pone.0153590