Tuberculosis-diabetes comorbidities

A study offers crucial insight into how diabetes mellitus alters the immune and metabolic response in individuals with tuberculosis (TB). By comparing inflammatory and lipid profiles across individuals with TB, DM, and both (TB-DM), the researchers found that TB-DM presents a unique biological signature. This includes elevated inflammatory proteins not seen in TB or DM alone, and a pro-atherogenic lipid profile marked by high VLDL and ApoB.

Notably, the study demonstrates that while inflammation generally decreases after two months of TB treatment, certain inflammatory markers remain disproportionately high in TB-DM, suggesting sustained immune activation. These inflammatory profiles were also linked to worse TB outcomes, particularly continued sputum positivity, which suggests persistent infection and increased treatment failure risk.

Lipid metabolism was equally impacted. TB-DM patients exhibited lipid patterns more closely resembling diabetic individuals, but with distinct increases in risk-associated markers like ApoB. Even during treatment, lipid levels, especially LDLs and ApoB, rose more significantly in TB-DM, reinforcing cardiovascular risk concerns.

These findings underscore the need to view TB-DM as a distinct clinical phenotype, not merely a coexistence of two conditions. Therapeutic strategies may need to be adapted for this group, including consideration of statins or anti-inflammatory agents. The data also support the potential use of inflammatory and lipid biomarkers to predict treatment response and tailor interventions.

Importantly, the study provides one of the largest datasets to date in this domain, strengthening the reliability of the conclusions and providing a framework for future personalized approaches in TB-DM care.

Sources:

1. Brake, J., Ajie, M., Sumpter, N.A., Koesoemadinata, R.C., Soetedjo, N.N., Santoso, P., Alisjahbana, B., Ruslami, R., Hill, P. and van Crevel, R., 2025. Inflammation and dyslipidaemia in combined diabetes and tuberculosis; a cohort study. iScience, 28(6).