The Bidirectional Relationship between Tuberculosis and Diabetes (original) (raw)
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Public Health Action, 2013
still exacts a huge toll, especially among the poorest people on the globe. Several key obstacles continue to thwart control efforts: many people are infected with Mycobacterium tuberculosis and are at risk of developing active TB during their lifetime; many vulnerable people with presumptive TB do not have access to affordable, high-quality TB diagnostic and treatment services; multidrug-resistant TB (MDR-TB, defi ned as M. tuberculosis resistant to at least isoniazid and rifampicin) is a serious threat in some settings; and in Africa, especially in the southern part of the continent, HIV/AIDS fuels an already burgeoning epidemic. Other risk factors have also emerged in recent years as important determinants of the TB epidemic, one of which is DM.
Detrimental association between diabetes and tuberculosis: An unresolved double trouble
Diabetes & metabolic syndrome, 2018
Despite significant efforts made to control tuberculosis (TB) through DOTS program, the increasing burden of diabetes mellitus (DM) threatens the progress in reducing TB-related mortality, particularly in developing countries. In recent years, TB-DM comorbidity continues to remain high in countries where DM is on rampant. DM increases the risk of TB, reactivates the dormant TB and worsens the TB treatment outcome. The present review highlights the current findings regarding the prevalence and association of TB-DM comorbidity along with their public health implications. This review will increase the awareness among researchers, policymakers and clinicians, regarding the current scenario of TB-DM association.
Journal of Family and Community Medicine, 2020
BACKGROUND: Tuberculosis (TB) and diabetes mellitus are still of much public health concern. Screening of TB patients for diabetes will ensure early case detection, better management of diabetes, and better TB treatment outcome. The objective of this study was to determine the prevalence and associated factors of diabetes in TB patients and their impact on treatment outcome of TB. MATERIALS AND METHODS: This was a longitudinal follow-up study of registered TB patients under the Revised National Tuberculosis Control Program in all five TB units of Bhopal district. Participants were contacted and the interview was conducted. The blood sugar of all TB patients was checked, and they were followed up to assess the treatment outcome from October 2014 to September 2017. Data were analyzed using SPSS (version 16.0. Chicago, SPSS Inc.). Logistic regression was done to find the factors for diabetes in TB patients. The Chi-square tests were used to find the difference in treatment outcomes and assess the relative risk for poor outcome in diabetic TB patients. RESULTS: Of total 662 TB patients, 82 (12.39%) were diagnosed as diabetic. Age >50 years, males, higher body mass index, pulmonary TB, patients on Category II treatment, and history of smoking were found to be predictors of diabetes in TB patients. The treatment outcome of TB was more unfavorable (defaulter, failure, and death) in diabetic TB patients (16.17%) than in nondiabetic TB patients (5.8%) (risk ratio = 2.78, 1.469-5.284 confidence interval). CONCLUSION: The high prevalence of diabetes and the unfavorable treatment outcome in diabetic TB patients make screening and management of diabetes at an early-stage crucial for a better outcome in TB patients.
Diabetes mellitus and tuberculosis facts and controversies
Journal of Diabetes & Metabolic Disorders, 2013
Tuberculosis (TB) and diabetes mellitus (DM) are both important health issues. A bidirectional association between them has been demonstrated by many researchers. The link of DM and TB is more prominent in developing countries where TB is endemic and the burden of diabetes mellitus is increasing. The association between diabetes and tuberculosis may be the next challenge for global tuberculosis control worldwide. Proper planning and collaboration are necessary to reduce the dual burden of diabetes and TB. One model similar to the TB-HIV program for prevention, screening and treatment of both diseases can be the best approach. In this paper, we review existing data and discuss the matters of controversy that would be helpful for determining research priorities in different countries.
Tuberculosis and Diabetes Mellitus: A Double Whammy for the Developing Nations
Journal of Medical Diagnostic Methods, 2015
With one-third of the estimated global population having tuberculosis and 10 million new cases added yearly, tuberculosis remains a persistent global public health problem requiring urgent attention. India has the highest tuberculosis burden (2.1 million new cases and 280,000 deaths annually) with the second largest diabetic population of the world. Nearly 40-50% adult population in India have tuberculosis infection; primary infection reactivates to clinical disease in 5-10% individuals, rest remaining latent. Conversion from latent to active disease is mainly due to underlying immunodeficiency states, diabetes being a pre-eminent cause. Tuberculosis and diabetes interact with each other at multiple levels. Diabetes triples the risk of tuberculosis. An estimated 15% of adult TB worldwide is attributed to diabetes. India and China together account for >40% of all diabetes associated tuberculosis cases; diabetes accounts for 14.8% of overall pulmonary and 20.2% smearpositive tuberculosis. Diabetic tuberculosis patients on anti-tubercular treatment (ATT) remain contagious longer than non-diabetics on ATT. Tuberculosis itself can lead to impaired glucose tolerance and overt diabetes. Moreover, certain anti-tubercular drugs interact with oral anti-diabetics, making diabetes control difficult. Development of universal, cost effective bi-directional screening methods for tuberculosis in diabetics and viceversa could improve outcome of both diseases. However, universal screening for diabetes alone is not feasible in developing nations; additional screening for tuberculosis or bi-directional screening would be an extra burden. Certain measures, based on context of local health systems and availability of resources can be adopted: (i) tuberculosis surveillance among diabetics in regions with medium to high tuberculosis burden; (ii) assessing costeffectiveness of universal tuberculosis screening in all diabetics; (iii) establishing dedicated referral system for diabetics with suspected tuberculosis to specialized centers; (iv) screening tuberculosis patients for diabetes at the start of ATT; (v) research in developing more effective treatment strategies for concurrent tuberculosis and diabetes.
Diabetes and tuberculosis: a review of the role of optimal glycemic control
Journal of Diabetes & Metabolic Disorders, 2012
Developing countries shoulder most of the burden of diabetes and tuberculosis. These diseases often coexist. Suboptimal control of diabetes predisposes the patient to tuberculosis, and is one of the common causes of poor response to anti-tubercular treatment. Tuberculosis also affects diabetes by causing hyperglycemia and causing impaired glucose tolerance. Impaired glucose tolerance is one of the major risk factors for developing diabetes. The drugs used to treat tuberculosis (especially rifampicin and isoniazid) interact with oral anti-diabetic drugs and may lead to suboptimal glycemic control. Similarly some of the newer oral anti-diabetic drugs may interact with anti-tuberculosis drugs and lower their efficacy. Therefore diabetes and tuberculosis interact with each other at multiple levelseach exacerbating the other. Management of patients with concomitant tuberculosis and diabetes differs from that of either disease alone. This article reviews the association between diabetes and tuberculosis and suggests appropriate management for these conditions.
Tuberculosis and diabetes mellitus: convergence of two epidemics
The Lancet Infectious Diseases, 2009
The link between diabetes mellitus and tuberculosis has been recognised for centuries. In recent decades, tuberculosis incidence has declined in high-income countries, but incidence remains high in countries that have high rates of infection with HIV, high prevalence of malnutrition and crowded living conditions, or poor tuberculosis control infrastructure. At the same time, diabetes mellitus prevalence is soaring globally, fuelled by obesity. There is growing evidence that diabetes mellitus is an important risk factor for tuberculosis and might affect disease presentation and treatment response. Furthermore, tuberculosis might induce glucose intolerance and worsen glycaemic control in people with diabetes. We review the epidemiology of the tuberculosis and diabetes epidemics, and provide a synopsis of the evidence for the role of diabetes mellitus in susceptibility to, clinical presentation of, and response to treatment for tuberculosis. In addition, we review potential mechanisms by which diabetes mellitus can cause tuberculosis, the effects of tuberculosis on diabetic control, and pharmacokinetic issues related to the co-management of diabetes and tuberculosis.
Diabetes and Tuberculosis – Old Associates Posing a Renewed Public Health Challenge
European Endocrinology, 2009
Diabetes and tuberculosis (TB) have existed for thousands of years. Today, the global burden of disease from diabetes and TB is huge and, in the case of diabetes, rapidly increasing. Recent systematic reviews show that diabetes is associated with an increased risk of TB, yet the potential public health and clinical importance of the association seems to be largely ignored. Irrespective of whether the association is causal or a result of co-morbid factors, in low-resource societies with a dual disease burden, can a common health system approach for diabetes and TB be adapted to address prevention and care? How and to what extent can this be done? Good-quality implementation research is urgently needed to create robust action plans to address this double burden.