The Effect of Type 2 Diabetes Mellitus on the Presentation and Treatment Response of Pulmonary Tuberculosis

Abstract

Background. Diabetes mellitus (DM) is a known risk factor for tuberculosis (TB), and with the increasing prevalence of type 2 DM in less developed regions, many patients with TB will have concomitant DM. Presently, little is known about the effect of DM on the clinical presentation and treatment outcome of TB.Methods. In an urban setting in Indonesia, 737 patients with pulmonary TB were screened for DM and were followed up prospectively during TB treatment. Clinical characteristics and outcome were compared between patients with TB who had DM and patients with TB who did not have DM.Results. DM was diagnosed in 14.8% of patients with TB and was associated with older age and a greater body weight. On presentation, diabetic patients with TB had more symptoms but had no evidence of more-severe TB. After 2 months, results of sputum microscopic examination was more often positive in diabetic patients (18.1% vs. 10.0%). After 6 months, 22.2% of cultured sputum specimens from diabetic patients were positive for Mycobacterium tuberculosis (adjusted odds ratio, 7.65;). P p .004 Conclusion. DM seems to have a negative effect on the outcome of TB treatment. The underlying mechanisms for the different response to treatment in diabetic patients with TB must be explored. Screening for DM and subsequent glycemic control may improve the outcome of TB treatment.

‘Diabetes and Tuberculosis’ – A Co-Epidemic of Public Health Importance in the Developing World

“…It is widely known that there is higher frequency of pulmonary TB in males. DM patients with TB appear to be older than non DM subjects 25 . DM was classified as type-2 (T2DM) in majority of studies in TB-DM 32 .…”

“…A delay in sputum conversion was observed in TB-DM patients 25,27,[34][35][36] . Restrepo et al 36 reported that within 60 days the mycobacterial clearance was delayed by 5 days.…”

“…One study conducted in Indonesia reported a higher symptom score in DM-TB patients 25 . In another study from Turkey, the only symptom more commonly found in diabetic patients was cough, suggesting that the distribution of symptoms is not seriously affected by DM 19 .…”

“…DM increases the risk of adverse treatment outcomes in patients with TB 25,32 . A delay in sputum conversion was observed in TB-DM patients 25,27,[34][35][36] .…”

An Observational Study to Determine the Impact of Glycaemic Control on Presentation of Drug Sensitive and Drug Resistant Pulmonary Tb in Type 2 Diabetes

“…10,11 DM constitutes a risk factor for active TB and might influence the disease presentation and response to treatment. 12,13 On the other hand, TB may induce glucose intolerance and aggravate glycemic control in patients with DM. 14,15 The higher susceptibility of TB in diabetics may be related to a longer duration of disease or due to poor control of glycemic status.…”