Clinical Challenges and Management Strategies for TB-DM

• TB and Glucose Metabolism: TB can lead to impaired glucose tolerance, which might normalize after treatment but increases the risk for T2DM due to stress, inflammation, and metabolic changes. See also: https://lintblab.weebly.com/group-members.html
• Hyperglycemia in TB: Hyperglycemia is common in TB patients (10-26% prevalence), resulting from systemic inflammation and altered metabolism.
• Immunometabolic Impact: TB causes significant changes like increased inflammation, altered adipose tissue function, and elevated free fatty acids, contributing to insulin resistance (IR).
• Lipid Dysregulation: TB infection increases free fatty acids, leading to high LDL, low HDL, high VLDL, and ectopic fat deposition in organs, promoting IR.
• TB-DM Co-occurrence: When TB and diabetes coexist, it complicates treatment, potentially leading to drug resistance and poorer outcomes.
• Impact on TB Treatment: Diabetes negatively affects TB treatment success, increasing mortality, failure rates, and loss to follow-up.
• Immune Deficiency in Diabetes: Diabetes compromises immune function, reducing TB control by impairing macrophage activity, cytokine release, and T-cell responses.
• Altered Immune Response in Latent TB: Diabetic patients with latent TB exhibit heightened inflammatory responses, suggesting altered immune signaling.
• Clinical Management: Integrated management of TB and DM/IR is necessary to prevent diabetes progression and improve TB outcomes.
• HbA1c Monitoring: Regular HbA1c monitoring during TB treatment helps identify individuals at risk for poor outcomes due to hyperglycemia.
• Diabetes Treatment: Effective diabetes management in TB patients leads to better clinical outcomes, reducing TB severity and complications.
• Symptom Severity: TB in diabetic patients often results in more severe symptoms, correlated with higher HbA1c levels.
• Cardiovascular Complications: TB increases the risk of cardiovascular diseases through metabolic and inflammatory pathways.
• CVD Risk Management: Screening for CVD risk factors and promoting lifestyle changes are crucial in TB patients to manage cardiovascular health.
• Interdisciplinary Approach: The management of TB alongside conditions like CVD and diabetes needs cross-specialty collaboration for optimal patient care.

References:

1. Pardeshi, G., Mave, V., Gaikwad, S., Kadam, D., Barthwal, M., Gupte, N., Atre, S., Deshmukh, S., Golub, J.E. and Gupte, A., 2024. Glycated Hemoglobin Trajectories and Their Association With Treatment Outcomes Among Patients With Pulmonary TB in India: A Prospective Cohort Study. Chest, 165(2), pp.278-287.
2. Chiang CY, Bai KJ, Lin HH, Chien ST, Lee JJ, Enarson DA, et al. (2015) The Influence of Diabetes, Glycemic Control, and Diabetes-Related Comorbidities on Pulmonary Tuberculosis. PLoS ONE 10(3): e0121698. doi:10.1371/journal. pone.0121698.
3. Bisht MK, Dahiya P, Ghosh S and Mukhopadhyay S (2023) The cause-effect relation of tuberculosis on incidence of diabetes mellitus. Front. Cell. Infect. Microbiol. 13:1134036. https://tbreadingnotes.blogspot.com/2024/11/the-cause-effect-relation-of-tb-on.html
4. Basham CA, Smith SJ, Romanowski K, Johnston JC (2020). Cardiovascular morbidity and mortality among persons diagnosed with tuberculosis: A systematic review and meta-analysis. PLoS ONE, 15(7), e0235821.
5. Shabil, M., Bushi, G., Beig, M.A., Rais, M.A., Ahmed, M. and Padhi, B.K., 2023. Cardiovascular manifestation in tuberculosis cases: a systematic review and meta-analysis. Current Problems in Cardiology, 48(7), p.101666.

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