Aspects of patients with pulmonary TB and DM

A total of 216 patients at Ramathibodi Hospital, a 1,200-bed university hospital in Bangkok, Thailand, were included in the analysis. Among them, 70 were known cases of diabetes mellitus (DM), 22 were newly diagnosed with DM, and 124 had tuberculosis (TB) without DM.[1]

Patients with TB and DM were more likely to have additional underlying conditions, such as dyslipidemia, hypertension, cardiovascular disease, obesity, and chronic kidney disease, compared to those without DM. Moreover, the TB-DM group had a higher proportion of positive sputum AFB and positive cultures for M. tuberculosis in bronchoalveolar lavage than the TB-only group.[1]

Patients with TB and DM also experienced a higher rate of treatment complications, particularly cutaneous reactions and nausea/vomiting. They had a lower proportion of cure at 6 months (although the cure rate was similar at 9 months) and a higher mortality rate at 6 months compared to those without DM. The odds ratio (OR) for death at 6 months in the TB-DM group was approximately 4.83, indicating that their odds of dying were about 4.83 times higher than those with TB alone.[1]

In another cohort of 140 pulmonary TB (PTB) patients, 61.4% had dysglycemia at baseline—47.1% with pre-DM and 14.3% with DM. Among those with DM, 65% had a prior diagnosis of type 2 DM. Patients with pre-DM and DM more frequently showed cavitary disease (84.8%) and bilateral lung lesions on chest X-ray, with a greater number of lung zones affected, compared to non-glycemic TB patients.[2]

Compared to those without dysglycemia, patients with pre-DM or DM had a higher prevalence of cavities (80.2% vs. 63.0%), bilateral lesions (67.4% vs. 46.0%), and a greater median number of affected lung thirds (3 vs. 2). Although follow-up imaging showed no significant differences in radiological improvement among groups, sputum smear positivity was significantly higher in the dysglycemic groups (93.0%) than in the non-glycemic group (75.9%). However, Xpert MTB/RIF and M. tuberculosis culture results were comparable. Interestingly, resistant M. tuberculosis strains were more common in non-glycemic and pre-DM patients than in those with DM. Independent factors associated with dysglycemia in PTB patients included higher BMI, cavitary lesions on CXR, and positive sputum smears.[2]

Reference:

1. Buasroung, P., Petnak, T., Liwtanakitpipat, P. and Kiertiburanakul, S., 2022. Prevalence of diabetes mellitus in patients with tuberculosis: a prospective cohort study. International Journal of Infectious Diseases, 116, pp.374-379.

2. Bezerra, A.L., Moreira, A.D.S.R., Isidoro-Gonçalves, L., Lara, C.F.D.S., Amorim, G., Silva, E.C., Kritski, A.L. and Carvalho, A.C.C., 2022. Clinical, laboratory, and radiographic aspects of patients with pulmonary tuberculosis and dysglycemia and tuberculosis treatment outcomes. Jornal Brasileiro de Pneumologia, 48(06), p.e20210505.