Why people with diabetes are at a high risk of tuberculosis

Glucometer with result of measurement sugar level, healthy food, dumbbells for fitness and tape measure, concept of diabetes, slimming, healthy lifestyle   | Photo Credit: ratmaner

“Never lose hope,” Ranjan (name changed to protect privacy), who is to celebrate his 50th birthday next month declared, Morgan Freeman- style. He is one of the thousands in our country who suffer from diabetes and tuberculosis.

Two months ago, when he developed a severe cough and fever, he didn’t know that he had a higher risk of TB due to diabetes. “I used to have very high sugar levels. Four years ago, it was 350-400 mg/dL. But I took my tablets properly and brought it down. I don’t know how I got TB.”

The link

The World Health Organization says that 15% of the global TB burden is now attributed to diabetes. A recent review pointed out that diabetes can double the lifetime TB risk.

“There are three major public-health issues related to TB and diabetes. First, a person with diabetes has lower immunity and therefore has a higher risk of having TB. Second, TB is presented differently, making the diagnosis difficult; and third, they are more likely to have a poor outcome of treatment,” explains Dr Roopa Shivashankar, who works with the Public Health Foundation of India in Delhi.

She is the author of a review paper published in Diabetes Metabolism Research and Reviews this January, which found that the prevalence of TB in diabetes and diabetes in TB was at least two-three times higher than that found in the general population.

It is a double-edged sword. In TB infections, the stress responses by the body result in impaired glucose tolerance, a risk factor for diabetes. Tuberculosis drugs (namely, rifampicin) also make it more difficult to maintain glucose control.

“People with diabetes should seek treatment if they have a cough lasting more than two weeks, fever, night sweats and/or weight loss,” instructs Dr Subash Babu, Scientific Director at the National Institute for Research in Tuberculosis, Chennai.

“People with Diabetes-TB seem to have greater residual lung function and lowered immunity than people who have only TB,” says Prof Vijay Viswanathan from the Diabetes Research Centre in Chennai, sharing the findings of a TB consortium called RePORT India funded by National Institutes of Health, US and Department of Biotechnology, India.

Treatment together

India has the largest number of TB patients in the world and the second-largest number with diabetes. The Revised National Tuberculosis Control Program of the Government of India has issued guidelines to screen all TB patients for diabetes. TB-diabetes patients undergo the same anti-TB treatment as the general population, but it helps if diabetes is kept under control.

The two diseases are dealt with by different programmes in India: National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS), and Revised National Tuberculosis Control Programme (RNTCP). There is an urgent need for the two to come together, says Dr Shivashankar.

Ranjan has been on TB treatment for two months now; he has eight more to go. But his doctor, Dr Balaji from Dr V Seshiah and Dr Balaji Diabetes Care Centre, Chennai, says that if he doesn’t maintain his blood sugar levels, or take his medicines properly, the duration of the treatment can increase. With the rise of multidrug-resistant TB, it is even more important that the person adheres to the treatment regimen.

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Printable version | Jan 24, 2022 10:46:51 AM |

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