Impact of glycemic control on TB treatment outcomes in patients with DM [TB0107]

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Risk factors for tuberculosis (TB) fall into two main categories: those recently infected with TB and those with an immunocompromised status. The latter includes individuals with HIV, diabetes mellitus (DM), transplant recipients, malnourished individuals, tobacco users, and those receiving immunosuppressive treatments. It was estimated that 629 million people expected to be impacted by DM by 2045. Diabetes increases the risk of TB incidence by 2-4 times and is associated with poorer treatment outcomes, doubling the risk of mortality during TB treatment.

Long-term hyperglycemia and poor glycemic control (PGC) impair immunity, leading to increased susceptibility to TB. In contrast, optimal glycemic control (OGC) has been shown to improve TB outcomes by enhancing phagocytic activity and other immunological defenses. Patients with OGC exhibit a reduced risk of adverse treatment outcomes, lower sputum positivity rates, and a decreased risk of cavitary lesions on radiologic examinations compared to those with PGC. The ability to achieve OGC appears to strengthen the body’s immune response, aiding in better control of TB infection and contributing to more favorable treatment outcomes.

Additionally, patients with OGC tend to show quicker bacterial clearance from the airways, which facilitates earlier detection and may reduce disease progression and transmission risks. However, multilobar involvement, isolated upper lobe involvement, and isolated lower lobe involvement do not significantly differ between patients with OGC and those with PGC, suggesting that OGC may have limited impact on TB lesion distribution in the lungs. Nevertheless, OGC is crucial for improving TB treatment outcomes and minimizing the risk of advanced disease. Health care providers should consider screening for DM and managing glycemic control in patients with TB to optimize treatment success.

Source: Zhao, L., Gao, F., Zheng, C. and Sun, X., 2024. The impact of optimal glycemic control on tuberculosis treatment outcomes in patients with diabetes mellitus: systematic review and meta-analysis. JMIR Public Health and Surveillance, 10, p.e53948.

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