Study of carbohydrate metabolism indicators in firstly diagnosed pulmonary tuberculosis patients

Abstract

Objective — to study the indicators of carbohydrate metabolism in patients with firstly diagnosed pulmonary tuberculosis, depending on the extent of the lesion and the presence of mycobacteria excretion.Materials and methods. 78 patients with firstly diagnosed pulmonary tuberculosis were examined, including 19 patients without mycobacteria excretion — Group 1 and 59 patients with mycobacteria excretion — Group 2. The control group — 20 healthy individuals, comparable by sex and age. The examination and diagnosis were carried out in accordance with the current order of the Ministry of Health of Ukraine. Additionally, patients underwent oral glucose tolerance test (OGTT), the fasting insulin level was determined, the insulin resistance index (HOMA-IR) and the body mass index were calculated. For statistical data processing, the general-purpose data processing software package Statistica for Windows version 13.2 was used.Results and discussion. Depending on the increase in the volume of lung lesions, a monotonic increase of the level of glycated hemoglobin was observed from 4.8 % (pathological changes within the lung lobe) to 6 % (total lesion of the lung) with a maximum value of 7.1 % in bilateral lung lesions. The results of the oral glucose tolerance test demonstrated a statistically significant increase of the indicator to a median level of 5.8 mmol/l in the group of patients with mycobacteria excretion compared to 4.7 mmol/l in the group without mycobacteria excretion. In patients with firstly diagnosed pulmonary tuberculosis, the fasting plasma insulin level on an empty stomach exceeded 3.8 times compared to the control group, and the HOMA-IR insulin resistance index almost 4 times, indicating an increased insulin secretion by pancreatic β-cells.Conclusions. An increased 2 hours blood glucose level, fasting insulin level, and the HOMA-IR index was typical for firstly diagnosed pulmonary tuberculosis patients, which indicates the development of insulin resistance, a pathological condition characterized by an insufficient biological response of the cell to insulin at its sufficient concentration in the blood. Compared with patients who had limited pathological changes, patients with bilateral lesions of the lungs were characterized by a more prolonged violation of carbohydrate metabolism, as indicated by the levels of glycosylated hemoglobin upon admission to the hospitalMycobacteria excretion, as a marker of an aggravated course of the disease, was accompanied by the appearance of latent carbohydrate metabolism disorders in the form of an increase of 2 hours blood glucose level, that is, an impaired glucose tolerance.