High sugar level in the blood of diabetics presents a perfect medium for the TB bacterium to grow

Diabetics are put on alert that their heart, kidneys, and eyesight can be affected if the blood sugar level is left unchecked. However, it is only recently that even doctors have been made aware of tuberculosis existing as a co-morbid condition.

Bacteria require a medium to grow. And the high sugar level in the blood of diabetics presents a perfect medium for the Mycobacterium Tuberculosis to grow.

“A diabetic is prone to any infection because of the low level of immunity,” says Sunny Orathel, assistant professor in Medicine and chest specialist at the Ernakulam Medical College.

The tuberculosis bacterium, which is prevalent in the country, finds a good host in the diabetics, he said.

A study in 2011 by the State TB Cell, under the Directorate of Health Services, covering all districts, found that 44 per cent out of a micro sample of 600 TB patients had diabetes.

It led to yet another larger study that is going on, said S. Jayasankar, State TB Officer. He said in the micro sample, 20 per cent of the patients were new to their diabetic status.

In Ernakulam, District TB Officer C. Suma said 644 TB cases had been detected in the last quarter of 2013. From the diabetic assessment report of 527 patients, 81 were found to be diabetic and 21 of these patients had been immediately put on insulin.

On the basis of the study, the Union government had made diabetic screening necessary for all TB patients, said Dr. Jayasankar. The study was published in Plos One, a peer-reviewed science journal.

The State has also brought the TB control programme together with the non-communicable diseases control programme, giving medicines for diabetes free to those with TB.

The late awakening to TB control came in 2012 when the Union Health Ministry made it mandatory to notify the disease. Till then, private practitioners had never followed a regime in TB control, said Dr. Orathel.

Only the State TB control programme managed to go after the patients to ensure that medicine is taken by the patient. Even now, the State is yet to get all reports from private hospitals and practitioners, said officials in the State TB Cell. However, the notification did increase the number of cases detected.

The chance of co-morbidity of diabetes and TB increases with age. The two diseases are most likely to coexist in the aged population when immunity levels come down.