Effect of uncontrolled DM and pre-DM on PTB treatment outcome [TB0106]

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In 2020, an estimated 370,000 new cases of tuberculosis (TB) were attributable to diabetes mellitus (DM). Globally, over 15% of people with TB have DM, compared to 9.3% of the general population. The number of global DM cases is expected to increase by 50% from 2019 to 2045. In the Republic of Korea, the prevalence of DM was 16.7% among adults in 2020, but only 65.8% of adults with DM were aware of their disease and treated with antidiabetic medications. Furthermore, only 24.5% of these individuals achieved optimal glycemic control. The incidence of TB in Korea was 44.6 per 100,000 people in 2021.

In Korea, a public-private mix TB control project was expanded nationwide in 2011. All patients are monitored and followed up until treatment completion. Patients with pulmonary TB and DM were older, predominantly male, had a higher body mass index (BMI), and a higher malignancy rate. The proportion of unfavorable outcomes was significantly higher in patients with DM than in those without DM. An unfavorable treatment outcome is defined as a composite of death, treatment failure, loss to follow-up, remaining on treatment, or transfer out. The higher incidence of unfavorable outcomes could be attributed to a higher mortality rate due to DM-related comorbidities, such as cardiovascular disease. Additionally, a higher risk of drug–drug interactions, adverse events, and high pill burdens could impose hardships on TB-DM management.

Routine screening for DM should be performed in patients with TB at the time of diagnosis. People with blood glucose levels significantly higher than the diagnostic threshold for DM require appropriate evaluation by a diabetologist. Prediabetes might involve transient, stress-induced dysglycemia, and its adverse effects on the immune response and treatment outcomes might be less severe than those of chronic DM. However, people with prediabetes at the time of TB diagnosis are still at a higher risk of developing overt DM and should be counseled to identify modifiable risk factors and follow healthy lifestyle advice. For patients with uncontrolled diabetes, TB treatment can be extended to nine months due to higher recurrence rates. Complicated and untreated DM leads to more adverse outcomes. Combining stringent glucose control with prolonged anti-TB treatment might benefit these patients.

Source: Kim KH, Kim HW, Kim YH, Park Y, Jung SS, Kim JW, et al. Effect of complicated, untreated and uncontrolled diabetes and pre-diabetes on treatment outcome among patients with pulmonary tuberculosis. Respirology. 2024; 29(7): 624–632.

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