Health status and treatment outcome of TB with DM cases, Gujarat [TB0104]

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The world is undergoing an epidemiological transition in disease burden, with a gradual decline in deaths from communicable diseases (CDs) and a steady rise in non-communicable diseases (NCDs). This shift has intensified competition for policy attention and resources between advocates for CDs, such as tuberculosis (TB), and those focused on NCDs, like cardiovascular diseases and diabetes mellitus (DM). The global increase in type 2 DM has emerged as a substantial challenge for TB control, as today more TB patients are living with diabetes than with concomitant human immunodeficiency virus (HIV) infection. Thus, the association between DM and TB may become the next significant challenge for global TB control.

The bidirectional relationship between TB and DM is well-documented. Diabetes is an independent risk factor for TB development, while TB can also lead to impaired glucose tolerance (IGT) and new-onset diabetes. Additionally, diabetes may alter TB symptoms, radiological findings, treatment outcomes, and prognosis. Both TB and DM significantly impact patients' quality of life (QoL), affecting both psychological and physical well-being.

An estimated 50% of DM patients in developing countries are unaware of their diagnosis, making TB clinics a critical point for new DM diagnoses worldwide. Diabetes negatively impacts TB treatment outcomes, delaying microbiological response, reducing favorable outcomes, and increasing risks of relapse, death, and drug resistance. TB may also progress more rapidly in people with diabetes, with TB patients who have DM exhibiting more symptoms (e.g., cough, hemoptysis, dyspnea, fever, night sweats, and weight loss) and a lower performance status.

Improved clinical outcomes in TB patients with DM indicate the effectiveness of current anti-TB treatments and enhanced DM management. These improvements highlight the value of regular healthcare interactions during TB treatment, which offer excellent opportunities for health education, counseling for improved diabetes control, and adherence to TB treatment.

Limitations in this study include potential selection bias, as cases were exclusively drawn from the government sector.

Source: Solanki HM, Ranpariya PN, Chudasama RK. Health status and treatment outcome of tuberculosis with diabetes mellitus cases, Rajkot City, Gujarat – A longitudinal study. Indian J Community Med 2023;48:75‑81.

 

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