Tuberculosis (TB) patients with diabetes (DM) were generally older, more often male, and exhibited higher rates of comorbidities such as hypertension and cardiovascular disease compared to non-diabetic TB patients. Despite these distinctions, there were no significant differences in symptoms, radiographic findings, or the prevalence of acid-fast bacilli (AFB) positivity on sputum smear tests between controlled diabetics and non-diabetics. However, diabetic TB patients, particularly those with uncontrolled diabetes, showed a higher incidence of cavitary lesions, although the extent and location of lung involvement remained similar across groups. The prevalence of AFB positivity on sputum smear was notably higher among diabetic patients at 59.5% compared to 40.4% in non-diabetics, with uncontrolled diabetics experiencing rates as high as 65.8%.[1]
See also: https://tbreadingnotes.blogspot.com/2024/09/burden-of-drug-susceptible-tuberculosis.html
The management of TB in diabetic patients revealed further complexities. Uncontrolled diabetes correlated with an increased number of cavitary lesions and a higher rate of positive culture conversion at the two-month mark. Treatment duration was extended in uncontrolled diabetics, averaging seven months, compared to six months in non-diabetics. This group also had higher rates of positive sputum smears and cavitary lesions, suggesting a more severe disease course. The increased susceptibility of diabetics to TB is largely attributed to compromised immune responses, highlighting the critical need for stringent diabetes management alongside TB treatment to mitigate these adverse outcomes.[1]
See also: https://tbreadingnotes.blogspot.com/2024/07/effect-of-diabetes-on-tuberculosis.html
A study was conducted at the Instituto Brasileiro para a Investigação da Tuberculose (IBIT) in Salvador, Bahia, which annually handles 10-15% of the city's TB cases. A cohort of 892 adults over 18 years with respiratory symptoms was prospectively studied. The median age was 49, with a majority being female (55.3%) and a median BMI of 22.6 kg/m². Lifestyle habits included chronic alcoholism (4.6%), smoking (42.4%), and illicit drug use (2.4%). Pulmonary tuberculosis (PTB) was diagnosed in 11.8% of the participants, with common comorbidities like COPD, HIV/AIDS, pulmonary silicosis, and cancer. PTB patients were predominantly male (54.3%), younger, had lower BMIs, and reported higher rates of chronic alcoholism. They also exhibited more frequent symptoms such as fever, night sweats, and weight loss compared to non-PTB patients.[2]
Prevalence of diabetes mellitus (DM) was notable, with 9% having a prior diagnosis and 63.1% showing signs of glucose metabolism disorder (GMD) with HbA1c levels of 5.7% or higher. An alarming 80% of PTB cases had elevated HbA1c at diagnosis, indicating a strong association between GMD and TB. Newly diagnosed DM patients showed increased Acid-Fast Bacilli (AFB) positivity in sputum smears, and the severity of TB symptoms correlated with the degree of GMD. Poor glycemic control (HbA1c ≥7.0%) quadrupled the likelihood of TB diagnosis. Among diabetic TB patients, those with higher HbA1c levels were more likely to have AFB positive samples. Regression analyses confirmed that DM, especially when uncontrolled, was significantly associated with TB risk. Moreover, the combination of smoking history and diabetes markedly increased TB risk, with an adjusted odds ratio of 6.3 for those with uncontrolled diabetes and a smoking history.[2]
References:
1. 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.
2. 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
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