DM increases the risk of developing TB

DM increases the risk of developing TB.[1]

People with diabetes face a significantly increased risk of tuberculosis (TB), being 2–3 times more likely to develop the disease than those without diabetes. The presentation of TB in diabetic individuals is often more severe, with symptoms including higher TB scores, more lung cavitation, and a longer duration needed to achieve negative smear or culture results. Treatment outcomes are also adversely affected, with poorly controlled diabetes doubling the mortality risk during TB treatment. Additionally, diabetes can increase the bacterial load of Mycobacterium tuberculosis, which might prolong infectiousness, and screening for TB in diabetic patients may not be highly effective outside high-incidence areas.[2]

Managing diabetes in TB patients presents unique challenges due to drug interactions, particularly with rifampicin, which accelerates the metabolism of many diabetes drugs, necessitating dose adjustments or alternative medications. Metformin is favored for its safety profile, low cost, and minimal interaction with rifampicin, though it does carry risks of gastrointestinal side effects and lactic acidosis, especially in those with impaired kidney function. Furthermore, to prevent the spread of TB, diabetic patients with active TB should avoid specialized diabetes services during the early stages of TB treatment, highlighting the need for integrated care approaches for managing both conditions concurrently.[2]

References:

1. Amelia, G. and Suryanto, J., 2024. Sensitivity Analysis of Diabetes Mellitus and Tuberculosis for Confounders: A Comprehensive Systematic Review. The Indonesian Journal of General Medicine, 1(1), pp.28-45.

2. van Crevel, R.; Critchley, J.A. The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice. Trop. Med. Infect. Dis. 2021, 6, 8.