Abstract
Objective: This study aimed to determine the decreased immune response of tuberculosis (TB) with diabetes mellitus (DM) patients.
 Methods: A total of 105 TB patients who were undergoing treatment at health centers and hospitals in Banda Aceh and Aceh Besar were included in this study. Data collection was carried out by interviewed to obtained demographic and respondent categories based on the diagnosis. Measurements of height and weight were also conducted to obtain body mass index data. 5 mL peripheral blood was taken from each respondent group into a TB with DM (TB+DM) and TB without DM (TB-DM). The blood tested usage tumor necrosis factor-alpha (TNF-α) level using enzyme-linked immunosorbent assay and interferon-gamma (IFN-γ) using IFN-γ release assay.
 Results: The average concentration of both TNF-α and IFN-γ was higher in TB-DM group (TNF-a 5.2 pg/mL; IFN-g 1.5 IU/mL) than in TB+DM group (TNF-a 2.06 pg/mL; IFN-g 2.86 IU/mL). There were significant differences in TNF-α between the two groups but no significant differences in IFN-γ protein concentration.
 Conclusion: The immune response of TB patients with DM symptoms was markedly reduced by the decreased expression of TNF-α and IFN-γ.
Highlights
Pulmonary tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis (M.tb)
People with Diabetes mellitus (DM) may increase the risk of developing TB by 1.5 times as research conducted in Jakarta and Bandung showed that the prevalence of DM in TB patients was around 17.1% and 11.6%, respectively [2]
For the TB with DM (TB+DM) group, most respondents were in the age range between 46 and 60 years, while in the TD-DM group, most were in the age range between 31 and 45 years
Summary
Pulmonary tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis (M.tb). According to the WHO, in 2017, 10 million people worldwide are infected with TB, while in 2018, RISKESDAS reported the prevalence of pulmonary TB in Indonesia reaches 0.4% and 0.5% in Aceh [1]. People with DM may increase the risk of developing TB by 1.5 times as research conducted in Jakarta and Bandung showed that the prevalence of DM in TB patients was around 17.1% and 11.6%, respectively [2]. The immune system responds to TB infection through tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ). Research by Lachamandes concluded that elevated blood glucose would increase TNF-α secretion in macrophages in TB patients. Kumar et al showed the increased expression of CD4 in the IFN-γ-secreting T cells in TB patients with DM [5]
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