Quality of Life & Social Determinants

Immune Dysfunction in T2DM-TB Comorbidity

• T2DM significantly impairs immune response in individuals with latent TB, shown by reduced cytokine levels (e.g., IFNγ, IL-2, IL-17) and poor mycobacterial growth control.
• This immunological vulnerability underscores the biological basis for increased TB progression risk in diabetics.
• Feasible suggestion: Routine immune profiling in T2DM patients could help identify those at higher TB risk, guiding early preventive interventions.

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Demographic & Clinical Risk Factors

• Age, BMI, and low income are consistent risk factors for TB-DM comorbidity across studies; older adults and those with normal-to-high BMI are especially vulnerable.
• Educational level and number of TB symptoms are also associated with greater risk and poorer outcomes.
• Feasible suggestion: Target screening and education efforts at older, overweight individuals with low educational attainment to detect and manage comorbidity earlier.

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Programmatic Gaps & Health System Challenges

• DOTS implementation is widespread but suffers from irregular coordination, understaffing, inadequate training, and weak infrastructure (e.g., lack of diagnostic tools, IT resources).
• Reliance on donor funding creates long-term sustainability concerns.
• Feasible suggestion: Strengthen local health system capacity through stable government investment, staff training, and decentralization of diagnostic tools.

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Quality of Life & Social Determinants

• TB-DM patients report worse physical and mental well-being and face environmental barriers (e.g., housing, access to care).
• Despite clinical symptoms, social conditions and perceived quality of life are major burdens, particularly among the underprivileged.
• Feasible suggestion: Integrate social support (housing, transport, counseling) into TB-DM care models to improve treatment adherence and overall outcomes.

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Innovative Education & Early Prevention

• Educational storybooks effectively improved TB knowledge and behavior (like cough etiquette) in children of TB patients.
• The method was effective regardless of family health history or home environment, suggesting its standalone impact.
• Feasible suggestion: Expand storytelling-based interventions as low-cost, scalable tools in TB-endemic areas to promote early prevention and intergenerational awareness.

Yoseph Samodra

References:

1. Dasan, B., Rajamanickam, A., Pandiarajan, A.N., Shanmugam, S., Nott, S. and Babu, S., 2025. Immunological mechanisms of tuberculosis susceptibility in TB-infected individuals with type 2 diabetes mellitus: insights from mycobacterial growth inhibition assay and cytokine analysis. Microbiology Spectrum, 13(1), pp.e01445-24.
2. Araia, Z.Z., Mesfin, A.B., Mebrahtu, A.H., Tewelde, A.G., Osman, R. and Tuumzghi, H.A., 2021. Diabetes mellitus and its associated factors in tuberculosis patients in maekel region, eritrea: analytical cross-sectional study. Diabetes, Metabolic Syndrome and Obesity, pp.515-523.
3. Nuraisyah, F., Juliana, N., Astaria, D., Khalisah, N., Al Fatih, D.M.F., Dewi, S.K. and Marwati, T., 2024. Risk Factors of Pulmonary Tuberculosis in Type 2 Diabetes Mellitus in Yogyakarta. Journal of Epidemiology and Public Health, 9(2), pp.194-203.
4. Sofiana, L., Muthiah, T.A.S. and Putri, N. (2024) Analysis of directly observed treatment shortcourse implementation as an effort to control tuberculosis in Yogyakarta. The Indonesian Journal of Public Health, 19(3), pp. 507–519.
5. Nugrahaeni, D.K., Kusumasari, I., Budiana, T.A., and Mauliku, N.E. (2025). Factors Associated with Tuberculosis-Diabetes Mellitus Comorbidity. Periodic Epidemiology Journal/Jurnal Berkala Epidemiologi, 13(1):75-84.
6. Penyami, Y., Angkasa, M.P. and Sumarni, S., 2025. Using storybooks to enhance health awareness among schoolchildren at risk of tuberculosis. Malahayati International Journal of Nursing and Health Science, 7(11), pp.1338-1343.

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