Diabetes Mellitus and Tuberculosis

Introduction:

Diabetes mellitus is a disease that affects how the body makes use of blood sugar (glucose). Tuberculosis is a disease caused by bacteria and affects the lungs. It can affect various other body parts as well.

What Is Diabetes Mellitus?

Diabetes mellitus comprises a group of diseases that are seen to affect the way the body utilizes blood sugar (glucose). Glucose is a vital element of energy for the cells that make up the muscles and tissues. The affected individual’s body does not form enough insulin or cannot use it as the way it should. When there is no presence of enough insulin or cells stop responding to insulin, excessive blood sugar remains in the bloodstream. Over time, this can result in serious health issues like heart disease, vision loss, kidney disease, and more. This disease has no definitive cure if it is type 1. A person who has type 2 diabetes might or might not require insulin. In many cases, medication, along with exercise and diet modifications, can help in the management of this condition.

What Is Tuberculosis (TB)?

Tuberculosis (TB) is a bacterial illness seen to attack the lungs primarily. But it can also attack other body parts, like the kidneys, spine, and brain. Not every individual infected with TB bacteria becomes ill. So, there are mainly two types of TB conditions:

1. Latent TB Infection- A condition where the TB germs are present in the body but do not make a person ill.

2. TB Disease (Active TB) - A condition where people get ill from the TB germs. TB disease can be managed with antibiotics anytime. But if it is not treated properly, it can turn into a fatal condition.

What Causes Tuberculosis (TB)?

TB is an infection seen due to a bacteria (germs) termed Mycobacterium tuberculosis. The germs are transmitted from one person to another via the means of air droplets.People who have TB in their throat or lungs transmit germs in the air when coughing, sneezing, talking, etc. . While breathing in the air that contains the germs, one can catch TB. TB is not seen to be transmitted through touching, kissing, or sharing food or dishes. One is more susceptible to catching TB from people they live or work with rather than from people they meet for a shorter duration of time.

How Are Diabetes Mellitus and Tuberculosis Related?

• The increase in type 2 diabetes mellitus (DM) is a well-identified re-emerging risk and challenge of tuberculosis (TB) management. Individuals who have DM are three times more susceptible to developing TB. In recent times, it has been seen that more number of individuals with TB-DM co-morbidity exists when compared with TB-HIV co-infection.

• The link between type 2 diabetes mellitus (DM) and tuberculosis is well observed, and the immune-metabolic changes that take place in diabetes are known to lead to increased susceptibility to tuberculosis. Many epidemiological studied reveal that the occurrence of hyperglycemia, while in the case of active TB, causes

• impaired glucose tolerance and insulin resistance. However, the mechanisms underlying these effects are not studies well.

What Is Diabetes Mellitus and Tuberculosis Co-morbidity?

Recent medical studies reveal the interactions between TB and diabetes. Some of these are the following:

• Around 10 percent of TB cases are linked to diabetes across the globe. People with a weak immune system as a result of chronic diseases like diabetes are more susceptible to progressing from latent to active TB. People with diabetes have a two to three times more risk of getting infected with TB when compared to people without diabetes.

• A large number of people with diabetes, as well as TB, are are not diagnosed timely or are diagnosed at a later stage. Due to late detection and late treatment, complications from TB–diabetes co-morbidity turn into producing high costs of treatment and excessive expenditure. Early detection can assist in improving the care and management of both these diseases.

• Diabetes can make the time long for sputum culture conversion. Therefore, this could result in the development of drug resistance if a drug regimen in the intensive phase of therapy is changed to a drug regimen in the presence of culture-positive TB.

• TB is also linked with worsening glycemic control in people who have diabetes. It has been studied that good glycemic control in TB patients can improve the result of treatment.

How Is Screening and Diagnosis of Combined Diabetes and Tuberculosis Done?

Screening of newly recognized TB patients for diabetes is recommended by WHO (World Health Organization) in its guidance and other national and international organizations and has been incorporated into DOTS (Directly Observed Therapy Shortcourse) management for TB in many countries, although this might not always be incorporated well in practice. International steps suggest that screening can be performed by a simple blood glucose or glycated hemoglobin test, although it is thought that around half of TB clinics do not have laboratory access across the world, even for blood glucose testing. Point-of-care tests might thus be helpful, particularly in recognizing very high levels of blood glucose where specialist input into care might be warranted, but they are less accurate and thus require proper interpretation.

How Is the Management of Diabetes and Tuberculosis Done?

Currently, recommended TB treatment is the same for patients with combined TB and diabetes compared to those with TB only. However, this might have to be re-taken into consideration as diabetes is linked with TB drug resistance, slower treatment response, and higher rates of toxicity, failure, and recurrent TB. While managing latent TB infection (LTBI) or active TB in patients with diabetes, it should be considered that a longer duration of therapy might be required because of the effect of drug-drug interactions on treatment efficacy. Drug-drug interactions are also linked with an elevated risk of side effects, making treatment adherence more challenging.

Conclusion:

Diabetes and TB are frequently seen to accompany many patients, which is a bit challenging to deal with. Screening of patients with active tuberculosis (TB) at regular time slots for diabetes mellitus (DM) should be made mandatory across all countries and settings.The approach to screening these diseases should be standardized and should preferably be done at the time of diagnosis and registration of TB.The first step is to take data of the TB patients, whether they already have DM, and screen those who do not have DM with a blood test.