Insulin Resistance and Tuberculosis

Indonesia ranks third in TB incidence and fourth in DM prevalence, with studies confirming a strong connection between the two diseases. Before insulin’s introduction in 1922, DM patients frequently succumbed to pulmonary TB, but prognosis has improved with modern TB treatments. Clinically, many Indonesian TB patients also have type 2 DM, presenting with more symptoms but without increased disease severity on diagnostic tests, indicating a complex interaction rather than direct exacerbation. Despite better treatment adherence and lower drug resistance rates, diabetic TB patients face challenges, including higher positive sputum culture rates after six months, even when other factors are considered. Given these complications, routine DM screening for all TB patients, particularly those over 35, is recommended to enhance disease management and treatment outcomes.[3]

In a study, Mtb-sensitized individuals were older, more frequently Hispanic, and less likely to consume alcohol than uninfected individuals, with no significant differences in poverty status or tobacco exposure. They had higher glucose levels—fasting (5.6 vs. 5.4 mmol/L, P = .007), postprandial (6.6 vs. 5.9 mmol/L, P = .048), and HbA1c—along with increased insulin resistance (+0.16 HOMA2-IR, P = .014), though β-cell function remained unchanged (P = .42).[1]

Mtb sensitization was linked to a higher prevalence of type 2 diabetes (adjusted PR: 1.54, P < .001). While overall prediabetes rates were similar, isolated impaired fasting glucose (IFG) was more common (21.4% vs. 14.3%, P = .008). Mediation analysis showed insulin resistance explained 18.3% of the Mtb-T2DM association (P < .001), whereas β-cell dysfunction was not a significant factor (P = .50). These findings suggest Mtb sensitization increases T2DM risk primarily through insulin resistance.[1]

A study in China found that mass TB screening among persons with diabetes (PWD) is feasible but not cost-efficient due to low detection rates, with high costs driven mainly by diabetes management rather than TB-related expenses. Targeted screening in areas with at least 100 TB cases per 100,000 people proved effective, while risk-stratified approaches may be more practical in lower-burden settings. Symptom-based screening alone was insufficient, emphasizing the need for comprehensive methods. Successful implementation relied on integrating diabetes and TB control programs, leveraging existing community-based diabetes screening efforts.[2]

References:

1. Magodoro, I.M., Aluoch, A., Claggett, B., Nyirenda, M.J., Siedner, M.J., Wilkinson, K.A., Wilkinson, R.J. and Ntusi, N.A., 2024, October. Association Between Mycobacterium tuberculosis Sensitization and Insulin Resistance Among US Adults Screened for Type 2 Diabetes Mellitus. In Open Forum Infectious Diseases (Vol. 11, No. 10, p. ofae568). US: Oxford University Press.

2. Liu, Q., You, N., Wen, J., Wang, J., Ge, Y., Shen, Y., Ding, X., Lu, P., Chen, C., Zhu, B. and Zhu, L., 2023. Yield and efficiency of a population-based mass tuberculosis screening intervention among persons with diabetes in Jiangsu Province, China. Clinical Infectious Diseases, 77(1), pp.103-111.

3. Alisjahbana, B., Sahiratmadja, E., Nelwan, E.J., Purwa, A.M., Ahmad, Y., Ottenhoff, T.H., Nelwan, R.H., Parwati, I., Meer, J.W.V.D. and Crevel, R.V., 2007. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clinical infectious diseases, 45(4), pp.428-435.