Tuberculosis In Diabetic Patients Research Articles

Diabetes mellitus and HIV infection among active tuberculosis patients in Northwest Ethiopia: health facility-based cross-sectional study

BackgroundThe prevalence of diabetes mellitus (DM) is increasing globally and its comorbidity with tuberculosis (TB) is re-emerging, especially in low- and middle-income countries.ObjectiveThe main aim of this study is to determine the prevalence of DM and HIV infection and their associated risk factors among active tuberculosis patients in Northwest Ethiopia.MethodsThis hospital-based cross-sectional study was conducted between February 1st and June 30th, 2017 among active TB patients in two hospitals of Northwest Ethiopia. Two hundred and sixty-seven active TB cases aged 18 years or older were screened for diabetes using fasting blood glucose (FBG) test. Semi-structured questionnaires were used to collect demographic data, lifestyle habits and clinical data. Identification of pre-diabetes or diabetes in TB patients was achieved according to American Diabetes Association guidelines (2016).ResultsPrevalence of DM and TB comorbidity was 11.5% (95% confidence interval, CI 7.8–15.2) compared to 24.9% (95% CI 20.1–30.1) for pre-diabetes. Prevalence of HIV/TB co-infection was 21.9% (95% CI 16.7–26.8). Risk of DM was higher in TB patients from a rural location (adjusted odds ratio, aOR 3.13, 95% CI 1.02–9.62, p = 0.046). Similarly, DM was higher in TB patients who have a family history of DM (aOR 4.54, 95% CI 1.31–15.68, p = 0.017). Furthermore, HIV/TB co-infection was identified as a predictor of DM comorbidity in active TB patients (aOR 5.11, 95% CI 2.01–12.98, p = 0.001).ConclusionThe magnitude of DM and pre-diabetes in active TB patients in Northwest Ethiopia was high, warranting collaborative efforts to improve screening and adopt better clinical management strategies for DM–TB comorbid patients. Furthermore, being rural residents, family history of DM and HIV/TB co-infection were found to associate with DM among TB patients, highlighting the importance of the above-mentioned risk factors in the clinical management of this comorbidity.

Prevalence of Tuberculosis in Diabetic Patients

Aim: To determine the frequency of tuberculosis in the patients of diabetes. Study design: Cross-Sectional Place and duration of study: Department of Pulmonology, Avicenna Medical College, Lahore from 1st March 2020 to 31st August 2020. Methodology: Two hundred patients of both genders were presented in this study. Patients detailed demographics age, sex and body mass index were recorded after taking proper consent. Patients admitted in outpatient department with diabetic duration greater than 5years. The different variants of pulmonary and extra pulmonary tuberculosis were measured. Results: There were 120(60%) males and 80(40%) were females with mean age was 51.8±18.22 years. The mean duration of diabetes was 11.5±9.19 years. 60% patients were addicted to gutka and smoking. Active tuberculosis was only found in 30(15%) cases. Pulmonary tuberculosis were 17(56.7%) and the rest 13(43.3%) were extra pulmonary tuberculosis. Eighteen (60%) patients had smear positive and 12(40%) had smear -ve TB. Conclusion: The frequency of tuberculosis in the diabetic patients was high as compared to other population. It can be cure by early diagnosed of disease otherwise multidrug-resistant tuberculosis can become serious health problem among public. Key words: Prevalence, Tuberculosis, Diabetic patient, Multidrug-resistant tuberculosis

Diabetes and Tuberculosis: Is There a Relationship?

Background: There is growing evidence that Diabetes Mellitus (DM) is an important risk factor for Tuberculosis (TB) and might affect disease presentation and treatment response. Risk factors for TB include HIV/AIDS, immune suppression (i.e. steroids), silicosis, malnutrition, smoke from domestic stoves and cigarettes, and DM. In recent decades, TB incidence has declined in high-income countries, but incidence remains high in countries that have high rates of HIV infection, malnutrition, and crowded living conditions. Furthermore, DM prevalence is increasing globally, fueled by obesity. Several case–control studies have shown that the odd ratios of developing TB in diabetic patients ranges from 2.44 to 8.33 compared with non-diabetic patients. Several large-scale longitudinal cohort studies have shown similar findings. Case: A 63-year-old male with poorly controlled type 2 DM (HbA1C of 15%), HTN, COPD and history of pulmonary TB who had previously received 2 courses of treatment, was admitted with sudden dyspnea with non-productive cough. In the ED, he was hypoxic, had bilateral pleural effusions, lower extremity edema and newly diagnosed acute systolic CHF. Sputum smear analysis was AFB positive and Mycobacterium tuberculosis was confirmed via PCR. The smear microbes were resistant to rifampin, poor sample limited further sensitivities, and the patient was started on empiric treatment for multi drug resistant TB with RIPE, Capreomycin, Linezolid, and Moxifloxacin. Endocrinology was consulted to assist in control of hyperglycemia. The patient was managed with high doses of insulin. At the time of discharge his blood glucose where in the range of 120–180 mg/dl during the entire day and the importance of having good BG control was reinforced. He continues his treatment for TB. Discussion: Diabetes leads to increased susceptibility to Mycobacterium tuberculosis infection and disease via multiple mechanisms, including those directly related to hyperglycemia, as well as indirectly via the effect on macrophage and lymphocyte function, leading to diminished ability to contain the organism. It is possible the refractory course of this patient’s TB and subsequent development of MDR disease was in part due to his poorly controlled diabetes due to poor compliance to prior regimens. Conclusion: DM is associated with increased risk of contracting TB, the possible delay in sputum culture conversion, increased mortality, and increased risk of recurrent and refractory disease. Adequate screening and treatment of DM may be essential to help prevent patients with diabetes from contacting the disease especially in countries with high prevalence of TB. Also, it is important to ensure adequate treatment response and prevent the development of multidrug resistant disease in diabetics who have already contracted TB.

Prevalence of Diabetes in Tuberculosis Patients in Kathmandu Valley, Nepal.

In this descriptive cross-sectional study, the data on the prevalence of diabetes mellitus (DM) among tuberculosis (TB) patients at the Urban Directly Observed Treatment Centers in the Kathmandu, Bhaktapur, and Lalitpur districts of Nepal were collected. The prevalence of DM was assessed in 67 previously treated TB (PTTB) and 214 new TB patients. DM was diagnosed in 8 PTTB and 20 new TB patients. Clinical interviews identified 14 patients with DM, rapid blood glucose test was used to diagnose DM in 4 patients, and oral glucose tolerance test was used to diagnose DM in another 4 patients. Impaired glucose tolerance and impaired fasting glycemia were observed in 8 and 5 patients, respectively. The 18-24-year age group had the largest number of new TB patients (82, 38.3%). However, the incidence of DM among TB patients was higher in the >35-year age group. Moreover, DM was diagnosed in 24.2% of PTTB patients and in 23.1% of new TB patients. To determine the impact of DM screening in TB patients, a larger number of samples should be analyzed. DM screening for patients with TB is expected to start in developing countries. This should be initiated by conducting clinical interviews about DM and glucose tests using rapid kits.

Diabetes among tuberculosis patients and its impact on tuberculosis treatment in South Asia: a systematic review and meta-analysis

The escalating burden of diabetes is increasing the risk of contracting tuberculosis (TB) and has a pervasive impact on TB treatment outcomes. Therefore, we conducted this systematic review and meta-analysis to examine the burden of diabetes among TB patients and assess its impact on TB treatment in South Asia (Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, India, Pakistan, and Sri Lanka). PubMed, Excerpta Medica Database (EMBASE), and CINAHL databases were systematically searched for observational (cross-sectional, case–control and cohort) studies that reported prevalence of diabetes in TB patients and published between 1 January 1980 and 30 July 2020. A random-effect model for computing the pooled prevalence of diabetes and a fixed-effect model for assessing its impact on TB treatment were used. The review was registered with PROSPERO number CRD42020167896. Of the 3463 identified studies, a total of 74 studies (47 studies from India, 10 from Pakistan, four from Nepal and two from both Bangladesh and Sri-Lanka) were included in this systematic review: 65 studies for the prevalence of diabetes among TB patients and nine studies for the impact of diabetes on TB treatment outcomes. The pooled prevalence of diabetes in TB patients was 21% (95% CI 18.0, 23.0; I2 98.3%), varying from 11% in Bangladesh to 24% in Sri-Lanka. The prevalence was higher in studies having a sample size less than 300 (23%, 95% CI 18.0, 27.0), studies conducted in adults (21%, 95% CI 18.0, 23.0) and countries with high TB burden (21%, 95% CI 19.0, 24.0). Publication bias was detected based on the graphic asymmetry of the funnel plot and Egger’s test (p < 0.001). Compared with non-diabetic TB patients, patients with TB and diabetes were associated with higher odds of mortality (Odds Ratio (OR) 1.7; 95% CI 1.2, 2.51; I2 19.4%) and treatment failure (OR 1.7; 95% CI 1.1, 2.4; I2 49.6%), but not associated with Multi-drug resistant TB (OR 1.0; 95% CI 0.6, 1.7; I2 40.7%). This study found a high burden of diabetes among TB patients in South Asia. Patients with TB-diabetes were at higher risk of treatment failure and mortality compared to TB alone. Screening for diabetes among TB patients along with planning and implementation of preventive and curative strategies for both TB and diabetes are urgently needed.

The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice.

Diabetes Mellitus increases the risk of developing Tuberculosis (TB) disease by about three times; it also doubles the risk of death during TB treatment and other poor TB treatment outcomes. Diabetes may increase the risk of latent infection with Mycobacterium tuberculosis (LTBI), but the magnitude of this effect is less clear. Whilst this syndemic has received considerable attention, most of the published research has focussed on screening for undiagnosed diabetes in TB patients or observational follow-up of TB treatment outcomes by diabetes status. There are thus substantial research and policy gaps, particularly with regard to prevention of TB disease in people with diabetes and management of patients with TB–diabetes, both during TB treatment and after successful completion of TB treatment, when they likely remain at high risk of TB recurrence, mortality from TB and cardiovascular disease. Potential strategies to prevent development of TB disease might include targeted vaccination programmes, screening for LTBI and preventive therapy among diabetes patients or, perhaps ideally, improved diabetes management and prevention. The cost-effectiveness of each of these, and in particular how each strategy might compare with targeted TB prevention among other population groups at higher risk of developing TB disease, is also unknown. Despite research gaps, clinicians urgently need practical management advice and more research evidence on the choice and dose of different anti-diabetes medication and effective medical therapies to reduce cardiovascular risks (statins, anti-hypertensives and aspirin). Substantial health system strengthening and integration may be needed to prevent these at risk patients being lost to care at the end of TB treatment.

Prevalence of Tuberculosis in Diabetic Patients Living in Rural Areas of Northern Iran in 2016

Background: Tuberculosis (TB) is a chronic bacterial infection. Simultaneous onset of diabetes and TB can interfere with the treatment and control of TB. Objective: This study aims to investigate the prevalence of TB in diabetic patients living in rural areas of northern Iran. Materials and Methods: Participants were 925 diabetic patients living in rural areas of Kordkuy County, Golestan, Iran. Data were collected using a checklist surveying demographic characteristics and medical records of patients. To diagnose TB, they underwent a TB skin test, sputum smear test, chest radiography, and referring to an infectious diseases specialist, if needed. Results: Seven hundred sixteen of participants were female. The mean age of participants and their mean duration of diabetes were 58.4±11.1 and 8.39±5.47 years, respectively. Results of test showed that 62 patients had abnormal chest x-ray; 14 had coughing more than two weeks; 1 had fever; 2 had night sweats; 11 had sputum; 152 had positive TB skin test result; 10 had a history of previous TB; and 1 had active TB. Conclusion: The prevalence and incidence of TB in diabetic patients is 60 and 6 times higher than in general population, respectively.

Impacts of metformin on tuberculosis incidence and clinical outcomes in patients with diabetes: A systematic review and meta-analysis

Background: Accumulating evidence suggested that the use of metformin had more benefits for both prevention and treatment of tuberculosis (TB) than non-metformin use in patients with diabetes mellitus (DM); however, it remains to be fully elucidated on this topic. Thus, we conducted a systematic review and meta-analysis of published studies to determine the association between metformin use and TB in diabetic patients. Methods and materials: The MEDLINE, EMBASE, Information Sciences Institute (ISI) Web of Science and Cochrane CENTRAL databases were searched from their inception to April 15, 2019. Studies that evaluated the use of metformin and TB disease were included. The quality of each study was evaluated through the Newcastle-Ottawa Scale (NOS). For pooled data, the relative risk (RR) and 95% CIs were calculated; otherwise, a systematic review. Results: Seventeen observational studies were included, with a low risk of bias on NOS. The meta-analysis showed that metformin use was associated with a significantly lower active TB incidence and mortality among individuals with DM (RR =0.51; 95% CI: 0.38–0.69, p ⩽ 0.001) and with TB-DM (RR = 0.34; 95% CI, 0.20–0.57, p ⩽ 0.001), respectively. Conclusion: This meta-analysis indicated metformin use brought benefits to both prevention and treatment outcomes of TB among diabetic patients. Randomized controlled trials (RCTs) are needed to confirm these associations.

Laboratory Findings Associated with Pulmonary Tuberculosis in Diabetic Patients

Background: An epidemic of diabetes is currently, both in developed and developing nations. The seriousness of the association of pulmonary tuberculosis and diabetes mellitus was first noted by the great Arab Physician Avicenna nearly 1000 years ago. The global figure of people with diabetes is projected to rise from the current estimate of 220 million to 300 million in 2025. Subjects and Methods: All type 2 diabetic patients reporting to MVJMC and RH will form the subjects for study. The study conducted over a period of 2 yrs. Adult patients with diabetes mellitus with pulmonary tuberculosis were included while Diabetic patients with extrapulmonary tuberculosis were excluded from the study. Results: LDL- 18% of the patients had an LDL value below 100. 40% of the patients had LDL value between 100 – 120. Only 42% of the patients had LDL values between 120-140. HDL: 22.0% of the patients had an HDL value below 30. 24% of the patients had HDL values between 30 – 40. Only 36.0% of the patients had HDL value between 40-50 and 18% of the patients had an HDL value between 50-60. Triglycerides: 56.0% of the patients had Triglycerides value below 150. 42% of the patients had Triglycerides value between 150 – 199. Only 2.0% of the patients had Triglycerides value between 200-499. Conclusion: Male preponderance of the disease was noted and Peak incidence of the disease was noted in the age groups of 31 – 40 and 41 – 50. The majority of our patients had poorly controlled blood sugars, suggesting that severe hyperglycemia is associated with the development of pulmonary tuberculosis and sputum positivity was more in patients aged ≤ 50 yrs. Early diagnosis and properly monitored treatment regimen is the only time tested answer to this problem.

Prevalence and Associated Risk Factors of Pulmonary Tuberculosis in Diabetic Patients

Background: One-third of India’s population is infected with mycobacterium tuberculosis; there are 12 million active tuberculosis cases in India. One person dies of Tuberculosis every minute in India. No other disease has so much sociological, economic and health significance as Tuberculosis has. In 2005 there were an estimated 8.8 million new cases of Tuberculosis worldwide, with 1.9 million of those occurring in India. In India in 2000, there were an estimated 481,573,000 people over the age of 25 years. Among these, 4.3% i.e. around 20,707,639 had diabetes, 19 and 939,064 developed. Subjects and Methods: The study conducted over a period of 2 yrs. Adult patients with diabetes mellitus with pulmonary Tuberculosis were included, while Diabetic patients with extrapulmonary Tuberculosis were excluded from the study. Results: The maximum incidence of pulmonary Tuberculosis was noted above the age of 30yrs were 13(26.0%). The peak incidence was in the age group of 31 – 40 and 41 – 50 yrs. The mean age is 52.62. As Shown in [Figgure 1], the total numbers of males were 64% and females were 36%. The male to female ratio was 2.11:1 As Shown in [Table 3], the distribution of patient according to their occupation noted were Skilled (18%), Unskilled (38%), Business (16%), Service (2%), Housewife (22%), and Student (4%). As shown in [Table 4], the socio-economic status among 50 patients was distributed into: Upper (2%), Upper Middle (22%), Upper lower (32%), Lower (12%), Lower middle (32%), and Lower-middle (32%). Conclusion: Early diagnosis and properly monitored treatment regimen is the only time tested answer to this problem. All diabetics at the initial diagnosis and every year must have an x-ray chest done. All diabetics with abnormal weight loss, unexplained cough, or sudden increase of insulin requirement should have sputum examination and chest x-ray done.

High-resolution computed tomography thorax evaluation of sputum positive/CBNAAT positive pulmonary tuberculosis in diabetic and non-diabetic patients

Background: Diabetes mellitus (DM) and pulmonary tuberculosis (TB) are major health problems in India. Diabetes being an immunosuppressive state is thought to be a risk factor for acquisition of TB. However, very few researches provide evidence demonstrating whether DM affects radiological diagnostic findings of pulmonary TB. Hence, this novel cross-sectional study was undertaken to find the difference between the high-resolution computed tomography (HRCT) findings of TB patients with diabetes to that from non-diabetics. Material and Methods: HRCT thorax scans were performed in patients diagnosed as pulmonary TB on the basis of sputum positivity or CBNAAT positivity. Patients were divided into diabetic and non-diabetic group. Patient details and clinical history were recorded and HRCT thorax findings were then compared in both groups. Results: Compared to non-diabetic patients (26.5%), the diabetic patients (53.1%) showed a higher detection rate of lesions at the lower lung lobe (p &lt; 0.05), non-segmental consolidation was also higher in diabetic group (28%) compared to non-diabetic group (2%) p &lt; 0.01), cavitary lesion was noted in 37.5% of diabetic group compared to 8.1% of non-diabetic group (p &lt; 0.01). Conclusion: CT findings of TB in diabetic patients are different from those in non-diabetic patients, with a higher occurrence of non-segmental distribution, cavitary lesion and lower lobes are more commonly affected in TB patients with diabetes.

Collision of two epidemics: prevalence of diabetes in tuberculosis patients in urban Ludhiana

Background: Co-association between tuberculosis (TB) and diabetes has been observed for more than 2000 years. The burden of the both diabetes and tuberculosis is very high in India. Diabetes in TB patient decreases the success of anti-tubercular therapy and overall cure rates, which causes social and economic burden to country. The objective of the study was to find out the prevalence of diabetes mellitus in patients with tuberculosis under RNTCP treatment.Methods: This cross-sectional study was conducted in DOTS centers under Civil Hospital TU of Ludhiana, Punjab. 300 TB cases, above 18 years of age were included and screened for diabetes. Patients were interviewed regarding demographic profile and family history of diabetes. Height, weight, blood pressure, BMI and waist hip ratio were recorded.Results: The prevalence of diabetes in tuberculosis patients was found to be 21.3% (known diabetics- 6.3%, new diabetes cases- 15%). There was a statistically significant association of diabetes with older age and high BMI.Conclusions: Specific guidelines for management of the dual disease may help in improving the overall success of treatment.

Tuberculosis associated with diabetes mellitus by age group in Brazil: a retrospective cohort study, 2007–2014

Diabetes mellitus (DM) has important implications for tuberculosis (TB), as it increases the risk for disease activation and is associated with unfavorable TB treatment outcomes. This study analyzed the association between TB and DM (TBDM) in Brazil from 2007 to 2014. This was a retrospective cohort study carried out in 709,429 new cases of TB reported to the national disease notification system of the Brazilian Ministry of Health. Sociodemographic and clinical data, test results, and treatment outcomes were analyzed. TBDM was found in 6.0% of TB cases, mostly in men aged 18-59 years. The lethality rate was 5.1% higher in all age groups with diabetes, except in those older than 60 years of age. The frequency of multi-drug-resistant tuberculosis (MDR-TB) in patients with DM was higher in those without DM, with a 1.6- to 3.8-fold increase in the odds of MDR-TB. The elderly showed an increase in the prevalence of TBDM from 14.3% to 18.2%. Women were more likely to have DM, and elderly women had 41.0% greater chance of having DM. Relapse was significant among patients younger than 17 years of age. TBDM was high in Brazil, affected all age groups, and was associated with unfavorable TB treatment outcomes. We emphasize the need for strategies for the clinical management of diabetic tuberculosis patients in Brazil aiming at minimizing relapses, deaths, and MDR-TB.

Severe pulmonary radiological manifestations are associated with a distinct biochemical profile in blood of tuberculosis patients with dysglycemia

BackgroundDiabetes mellitus (DM) is thought to affect tuberculosis (TB) clinical presentation and treatment response. Whether DM impacts radiological manifestations of pulmonary TB is still not clear. This study investigated the impact of glycemic status on radiological manifestations of pulmonary TB cases and its relationship with concentration of biochemical parameters in peripheral blood.MethodsA retrospective cross-sectional study used data from 132 microbiologically confirmed pulmonary TB patients from Lima, Peru, evaluated in a previous investigation performed between February and December 2017. Chest radiographs were analyzed by a radiologist and a pulmonologist. Radiographic lesions were identified as cavities, alveolar infiltrates and fibrous tracts. Hyperglycemia in TB patients was identified by use of fasting plasma glucose, HbA1c and oral glucose tolerance test. Clinical, biochemical and hematological parameters were also analyzed.ResultsTB patients with hyperglycemia presented more frequently with cavities, alveolar infiltrates and fibrous tracts than those with normoglycemia. Hierarchical clustering analysis indicated that patients with more diverse and higher number of lung lesions exhibited a distinct laboratorial profile characterized by heightened white blood cell counts and circulating levels of total cholesterol, triglycerides and transaminases and simultaneously low levels of albumin and hemoglobin. Multivariable regression analyses adjusted for age, sex, prior TB, hemoglobin levels and acid-fast bacilli ≥2+ in sputum smears, demonstrated that presence of prediabetes or diabetes in TB patients was associated with increased odds of having 3 pulmonary lesion types (p = 0.003 and p < 0.01 respectively) or ≥ 4 lesions (p = 0.001 and p = 0.01 respectively).ConclusionHyperglycemia (both DM and prediabetes) significantly affected the presentation of radiographic manifestations and the number of lesions in pulmonary TB patients as well as the biochemical profile in peripheral blood.

Diabetes in tuberculosis patients: An emerging public health concern and the determinants and impact on treatment outcome.

BACKGROUND:Tuberculosis (TB) and diabetes mellitus are still of much public health concern. Screening of TB patients for diabetes will ensure early case detection, better management of diabetes, and better TB treatment outcome. The objective of this study was to determine the prevalence and associated factors of diabetes in TB patients and their impact on treatment outcome of TB.MATERIALS AND METHODS:This was a longitudinal follow-up study of registered TB patients under the Revised National Tuberculosis Control Program in all five TB units of Bhopal district. Participants were contacted and the interview was conducted. The blood sugar of all TB patients was checked, and they were followed up to assess the treatment outcome from October 2014 to September 2017. Data were analyzed using SPSS (version 16.0. Chicago, SPSS Inc.). Logistic regression was done to find the factors for diabetes in TB patients. The Chi-square tests were used to find the difference in treatment outcomes and assess the relative risk for poor outcome in diabetic TB patients.RESULTS:Of total 662 TB patients, 82 (12.39%) were diagnosed as diabetic. Age >50 years, males, higher body mass index, pulmonary TB, patients on Category II treatment, and history of smoking were found to be predictors of diabetes in TB patients. The treatment outcome of TB was more unfavorable (defaulter, failure, and death) in diabetic TB patients (16.17%) than in nondiabetic TB patients (5.8%) (risk ratio = 2.78, 1.469–5.284 confidence interval).CONCLUSION:The high prevalence of diabetes and the unfavorable treatment outcome in diabetic TB patients make screening and management of diabetes at an early-stage crucial for a better outcome in TB patients.

Clinicopathological Impact of Diabetes Mellitus in Pulmonary Tuberculosis Patients

Background: Tuberculosis (TB) is the one of the leading cause of death globally, more marked in developing countries like Bangladesh. The prevalence of Diabetes Mellitus (DM) is increasing globally fueled by obesity endemic. The study is designed to get an idea about prevalence and clinical impact of DM among pulmonary TB patients.&#x0D; Objective: The aim of the study is to find out the rate and effect of Diabetes mellitus in patients with pulmonary Tuberculosis. Material and Methods: This was a cross sectional study conducted in DOTS (directly observed therapy, short course) corner, outpatient department (OPD), Dhaka Medical College &amp; Hospital, Dhaka from July to December 2012. 125 patients of pulmonary Tuberculosis were included in this study as case. 125 age and sex matched controls who were not suffering from pulmonary Tuberculosis were taken from the attendant of the patients who had given the consent. Prevalence and clinical impact of diabetes mellitus was sort out in both case and control group and compared with each other.&#x0D; Results: The study shows the prevalence of DM among pulmonary TB patients is 26.4% and among normal population (non TB patients) is 20.8%. The relative risk (odds ratio) of DM among pulmonary TB patients is 1.27 times more than non TB person with p-value - 0.02, which is significant. In symptoms analysis, diabetic patients have got more haemoptysis (45%), in contrast to non-diabetic group (13%), with p-value-0.001. In non-diabetic patients Fever are more common, 88% in contrast to diabetic group 57%, p-value-0.001. Sputum positivity is more common (69%) among diabetic pulmonary TB patients than non diabetic pulmonary TB patients (58%). On chest X ray findings this study reveals that pulmonary TB patient with DM having cavitary lesion is 33% while it is only 9.76% in non-diabetic persons.&#x0D; Conclusion: This study found that there was greater prevalence of DM among pulmonary TB patients (26.4%) than non pulmonary TB persons (20.4%). This findings provides the information that health care provider should intensively search presence of DM in pulmonary TB patients.&#x0D; TAJ 2019; 32(1): 46-53

Glycerophospholipid Metabolism Alterations in Patients with Type 2 Diabetes Mellitus and Tuberculosis Comorbidity

Type-2 Diabetes (T2D) is a predisposing cause for developing tuberculosis (TB) in low- and middle-income countries. TB-T2D comorbidity worsens clinical control and prognosis of the affected individuals. The underlying metabolic alterations for this infectious-metabolic disease are still largely unknown. Possible mediators of the increased susceptibility to TB in diabetic patients are lipids levels, which are altered in individuals with T2D. To evaluate the modulation of glycerophospholipids in patients with TB-T2D, an untargeted lipidomic approach was developed by means of ultra-performance liquid chromatography (UPLC) coupled to electrospray ionization/quadrupole time-of-flight mass spectrometry (ESI-QToF). In addition, tandem mass spectrometry was performed to determine the identity of the differentially expressed metabolites. We found that TB infected individuals with or without T2D share a common glycerophospholipid profile characterized by a decrease in phosphatidylcholines. A total of 14 glycerophospholipids were differentially deregulated in TB and TB-T2D patients and could potentially be considered biomarkers. It is necessary to further validate these identified lipids as biomarkers, focusing on the anticipate diagnosis for TB development in T2D predisposed individuals.

The appearance of tuberculosis in diabetic patients.

Introduction: Tuberculosis is one of the greatest causes of death caused by infectious diseases. Almost one third of the world population (meant 2 billion) are infected by tuberculosis and vulnerable to tuberculosis. Diabetes is one of the most common non contagious diseases in the world. This disease is the fourth or fifth cause of death in the most of developed countries. The relationship between tuberculosis and diabetes had been introduced years ago and diabetes is considered as a threatening factor in tuberculosis in the research history. Not only tuberculosis is prevalent among diabetic persons, but also diabetic can affect the appearances of imaging of tuberculosis. Material and methods: This is a kind of analytic study, a case control study, which was carried out between years 93-94 in Zabol. In this study, the radiographic findings from the patients suffering from pulmonary tuberculosis in diabetic patients and not diabetic patients are compared. These radiographies handed in to a radiologist and the radiologic findings of these graphs from the anatomic location (upper and lower half of the right and left bellows), Presence or absence of cavities, nodules, density and pleural involvement were recoded and compared with diabetic and non-diabetic group. After gathering of the data using SPSS software, descriptive statistics was presented in the form of (frequency, percent) graphs and a chi-square test (p<0/05) was used to analysing and comparing of the results of diabetic and un-diabetic patients. Result: The population of the study was consisted of Chest radiograph for 124 TB patients which 61 (49/19%) were suffering from diabetics. In this study, 45 (71/43%) non-diabetic and 42 (65/85%) diabetic patients were women (p=0/7). There were 12 (19/67%) diabetic TB patients and 3 (4/76%) nondiabetic- TB patients with the consolidation of middle part of left lung (p=0/01) and 8 (13/11%) diabetic TB and 1 (1/59%) non-diabetic TB with reticulonoduler infiltration of lower part of left lung (p=0/02). There was no significant deference in rest of the radiographic results. Discussion and conclusion: The findings of this study indicate that reticulonoduler infiltration and consolidation of lower and middle part of lung in TB diabetic patients is more than TB non-diabetic patients and diabetes can affect findings of pulmonary tuberculosis radiography.

Glycemic control in tuberculosis: Lessons learned from Taiwan

The global epidemic of diabetes and tuberculosis poses challenges to the control of both diseases. Patients with tuberculosis and diabetes experience worse clinical manifestations, increased risk of treatment failure, recurrence, and death. Diabetes is also associated with risk for latent tuberculosis infection. Management of hyperglycemia reduces the risk and improves the outcome of tuberculosis in diabetic patients. Recent epidemiological studies from Taiwan have provided new and important information on the benefits of metformin in tuberculosis. When addressing the issue of multidrug-resistant tuberculosis, a shortened anti-tuberculous therapeutic regime seems a feasible approach for better cure rates, with less loss-to-follow.

Increase Incidences Tuberculosis in Diabetic Patients in Developing Countries

Increase Incidences Tuberculosis in Diabetic Patients in Developing Countries