Tuberculosis and diabetes: the deadly duo

Abstract

Background: With diabetes on the rise globally and with enormous pools of latent TB infection and high burdens of active disease in many countries, tuberculosis-diabetes is a looming co-epidemic. Furthermore, in countries where diabetes is escalating and tuberculosis rates are already high, diabetes will increasingly impede efforts to control tuberculosis. Methods: A prospective study including fifty diabetic and fifty non diabetic sputum positive pulmonary tuberculosis patients was conducted for a period of one year. Thorough clinical examination, relevant investigations like blood sugars, chest X-ray, and smear for acid fast bacilli were done and results analyzed statistically. Results: Though there is no significant difference in the clinical symptoms in both the groups, diabetic tuberculosis patients have prominent clinical severity at the onset, a greater degree of lung involvement and residual changes. There is predominance of lower zone involvement (56%) in diabetic patients and upper and mid zone involvement in non-diabetics. Extensive bilateral lesions and cavitations were more in diabetic patients. Sputum negativity after completion of intensive phase treatment was lower in diabetic patients compared to non-diabetics. Patients on insulin have better sputum conversion (94%) in comparison with oral hypoglycemic agents (76%). Relapse rate was high in diabetics (23.3%) compared to non-diabetics (8%). Conclusions: Diabetes mellitus is growing rapidly worldwide and is increasingly fueling the spread of tuberculosis. Atypical presentations like lower lung field involvement and cavitations were common. Strict glycaemic control enhances the sputum clearance and results in better patient outcome.