Impact of hyperglycemia on tuberculosis treatment outcomes [TB0111]

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Hyperglycemia impairs the immune system, reducing the body's ability to respond effectively to Mycobacterium tuberculosis (M. tuberculosis). This weakened response can lead to delayed bacterial clearance, prolonged infectivity, and an increased risk of TB relapse. Hyperglycemia also disrupts the balance between pro-inflammatory and anti-inflammatory cytokines, creating an unfavorable immune environment for TB control. Recognizing the impact of hyperglycemia on TB treatment outcomes is essential for improving patient care and developing effective management strategies.

In our cohort study of 791 patients with pulmonary TB (PTB) in Shandong Province, China, 33.6% (266 patients) exhibited hyperglycemia. While smoking and drinking habits were similar between hyperglycemic and non-hyperglycemic groups, patients with hyperglycemia were predominantly older, male, married, rural residents, and had lower educational levels and a higher BMI.

Hyperglycemic patients also had more extensive lung involvement, with a higher number of cavitated lung segments compared to non-hyperglycemic patients, both before and two months after treatment. Despite this, generalized estimating equation (GEE) analysis indicated that hyperglycemia did not significantly affect pulmonary lesions in TB patients. However, before treatment, hyperglycemic TB patients had higher incidences of TB severity scores >4, cough, fatigue, and night sweats. Even after two months of treatment, they continued to experience higher rates of cough, sputum production, and night sweats.

Adjusting for confounding factors, GEE analysis revealed that hyperglycemic patients had a 1.569-fold increased risk of elevated TB scores (95% CI 1.040–2.369) compared to those without hyperglycemia. The risk of major symptoms such as cough and night sweats was 1.332 times (95% CI 1.050–1.690) and 1.694 times (95% CI 1.228–2.335) higher, respectively, in hyperglycemic patients. Additionally, they had a higher rate of positive sputum tests before and two months after starting treatment, with a 1.941-fold greater likelihood of positive sputum test results (95% CI 1.382–2.727).

Patients with hyperglycemia also had a higher incidence of abdominal distension before treatment and experienced significantly higher rates of vomiting, diarrhea, and constipation after two months of treatment. Overall, hyperglycemia was associated with increased gastrointestinal side effects and may significantly impact the effectiveness of anti-TB treatment.

Source: Yanqiu X, Yang Y, Xiaoqing W, Zhixuan L, Kuan Z, Xin G, Bo Z, Jinyu W, Jing C, Yan M, Aiguo M. Impact of hyperglycemia on tuberculosis treatment outcomes: a cohort study. Scientific Reports. 2024 Jun 12;14(1):13586.

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