TB treatment and resulting abnormal blood glucose [TB0077]

Williams, V., Onwuchekwa, C., Vos, A.G., Grobbee, D.E., Otwombe, K. and Klipstein-Grobusch, K., 2022. Tuberculosis treatment and resulting abnormal blood glucose: a scoping review of studies from 1981-2021. Global Health Action, 15(1), p.2114146.

  • Diabetes as a Risk Factor for Tuberculosis (TB):

    • Numerous studies suggest that diabetes (DM) is a risk factor for TB.
    • It remains unclear whether TB or its treatment increases the risk of developing diabetes.
    • Impaired glucose tolerance (IGT) may occur during treatment with anti-TB drugs and might resolve after treatment.
    • This IGT could result from:
      • Undiagnosed diabetes.
      • A stress response to infection, which increases levels of stress hormones (interleukin-1, interleukin-6, TNF-alpha).
      • Abnormal pancreatic function or TB-induced pancreatitis affecting endocrine function.

  • Blood Glucose Testing During TB Treatment:

    • The Fasting Blood Glucose (FBG) test was the most common method for estimating blood sugar, followed by the Oral Glucose Tolerance Test (OGTT) and HbA1c.
    • There was no standardized approach for blood sugar testing; most studies used a combination of methods.
    • In studies using multiple tests:
      • HbA1c values were higher.
      • Patients with baseline values in the DM or IGT range were more likely to maintain hyperglycemia throughout treatment.
    • HbA1c is useful for identifying long-term glucose abnormalities.
    • To better identify DM comorbidity during TB treatment, blood glucose screening timing should be standardized across patients and country programs.
    • Some studies only repeated glucose measurements for patients with initial readings in the DM or IGT range, excluding those with normal baseline values.
      • This approach could miss new cases of DM or hyperglycemia during follow-up.
      • It may have been a cost-saving measure or focused on tracking patients with abnormal readings.

  • Trends in Blood Glucose Levels During TB Treatment:

    • Mean blood glucose levels decreased in patients with baseline values in the DM or IGT range who were not previously diagnosed with DM after starting TB treatment.
    • The prevalence of elevated blood glucose also decreased during follow-up, consistent with earlier findings that stress hormones in response to the disease may cause initial high blood glucose levels.
    • Some patients experienced persistent hyperglycemia after TB treatment, which may be due to:
      • Undiagnosed diabetes before TB infection.
      • Pre-existing IGT, which develops into DM due to additional insulin resistance from infection.

  • Cavitary Lung Lesions and Hyperglycemia:

    • The development of cavitary lung lesions suggests a severe immune response during TB infection and may be associated with hyperglycemia.
    • Glucose values typically improve over time with effective TB treatment.
    • Good TB treatment outcomes are achievable in DM patients with adequate glucose control.

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