The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice

Abstract

Diabetes Mellitus increases the risk of developing Tuberculosis (TB) disease by about three times; it also doubles the risk of death during TB treatment and other poor TB treatment outcomes. Diabetes may increase the risk of latent infection with Mycobacterium tuberculosis (LTBI), but the magnitude of this effect is less clear. Whilst this syndemic has received considerable attention, most of the published research has focussed on screening for undiagnosed diabetes in TB patients or observational follow-up of TB treatment outcomes by diabetes status. There are thus substantial research and policy gaps, particularly with regard to prevention of TB disease in people with diabetes and management of patients with TB–diabetes, both during TB treatment and after successful completion of TB treatment, when they likely remain at high risk of TB recurrence, mortality from TB and cardiovascular disease. Potential strategies to prevent development of TB disease might include targeted vaccination programmes, screening for LTBI and preventive therapy among diabetes patients or, perhaps ideally, improved diabetes management and prevention. The cost-effectiveness of each of these, and in particular how each strategy might compare with targeted TB prevention among other population groups at higher risk of developing TB disease, is also unknown. Despite research gaps, clinicians urgently need practical management advice and more research evidence on the choice and dose of different anti-diabetes medication and effective medical therapies to reduce cardiovascular risks (statins, anti-hypertensives and aspirin). Substantial health system strengthening and integration may be needed to prevent these at risk patients being lost to care at the end of TB treatment.

Interplay Among the Oral Microbiome, Oral Cavity Conditions, the Host Immune Response, Diabetes Mellitus, and Its Associated-Risk Factors—An Overview

“…Conversely, the increase in GSH positively regulates the production of IFN-γ and IL-12, favoring the immune response in DM2 against infection by this microorganism [ 69 , 70 ]. In this way, DM increases the risk of developing tuberculosis by about three times, doubles the risk of death during treatment of the disease, and can also increase the risk of infection by latent M. tuberculosis in diabetic patients [ 73 ].…”

Bidirectional screening and treatment outcomes of diabetes mellitus (DM) and Tuberculosis (TB) patients in hospitals with measures to integrate care of DM and TB and those without integration measures in Malawi

“…With an increasing global prevalence of TB and DM comorbidity, integrated approaches to care for effective management of both diseases especially in LMICs where heath systems are weak, TB is endemic, and where 80% of global type 2 DM are found [ 7 ] have been recommend. In this study, we found that 9.4% of the screened TB patients were living with DM which is suggesting high prevalence of TB among DM patients and high DM among TB patients than in general population in Malawi where prevalence of DM is approximately 5.6%, hypertension is 33%, HIV infections is 9.0% [ 18 , 34 ], and that of TB is 181 (113–265) per 100,000 [ 24 ].…”

“…According to World Health Organisation (WHO) TB screening guidelines, uncontrolled DM doubles the risk of TB treatment failure, relapse and death [ 1 ], and both DM type 1 and DM type 2 (T2DM), are risks factors for the development of active TB with T2DM accounting for more than 90% of TB cases attributed to DM [ 5 ]. Although studies are still being conducted to better understand the immunological mechanisms of susceptibility of TB among people with Diabetes mellitus (PWD), several factors [ 6 ] in relation to complex natural history of TB progression [ 7 ] have already been endorsed that would increase the risk of TB among PWDs.…”

Diabetes-Associated Susceptibility to Tuberculosis: Contribution of Hyperglycemia vs. Dyslipidemia

“…T2D is a known risk factor for cardiovascular events and studies have shown that TB itself is also associated with an increased risk of ischemic stroke and myocardial infarction [98][99][100][101], even after a successful TB treatment course [100]. TB-T2D co-morbidity is expected to significantly increase the risk of cardiovascular diseases; however, cardiovascular risk and appropriate therapeutic interventions are poorly studied in patients with TB-T2D [102].…”