Clinical management of concurrent diabetes and tuberculosis and the implications for patient services

Abstract

Diabetes triples the risk for active tuberculosis, thus the increasing burden of type 2 diabetes will help to sustain the present tuberculosis epidemic. Recommendations have been made for bidirectional screening, but evidence is scarce about the performance of specific tuberculosis tests in individuals with diabetes, specific diabetes tests in patients with tuberculosis, and screening and preventive therapy for latent tuberculosis infections in individuals with diabetes. Clinical management of patients with both diseases can be difficult. Tuberculosis patients with diabetes have a lower concentration of tuberculosis drugs and a higher risk of drug toxicity than tuberculosis patients without diabetes. Good glycaemic control, which reduces long-term diabetes complications and could also improve tuberculosis treatment outcomes, is hampered by chronic inflammation, drug-drug interactions, suboptimum adherence to drug treatments, and other factors. Besides drug treatments for tuberculosis and diabetes, other interventions, such as education, intensive monitoring, and lifestyle interventions, might be needed, especially for patients with newly diagnosed diabetes or those who need insulin. From a health systems point of view, delivery of optimum care and integration of services for tuberculosis and diabetes is a huge challenge in many countries. Experience from the combined tuberculosis and HIV/AIDS epidemic could serve as an example, but more studies are needed that include economic assessments of recommended screening and systems to manage concurrent tuberculosis and diabetes.

Metformin Adjunctive Therapy Does Not Improve the Sterilizing Activity of the First-Line Antitubercular Regimen in Mice

“…Alternatively, the inclusion of rifampin in our study may have altered the pharmacokinetics of MetF. Although concurrent use of rifampin and MetF may result in increased plasma concentrations of the latter in humans (17), it is possible that rifampin may accelerate the clearance of MetF and reduce drug exposures in BALB/c mice (18). Adjunctive therapy with host-modulating agents likely must strike a balance between an antimicrobial effect and excessive host inflammation, which may promote bacterial growth.…”

Moxifloxacin Is a Potent In Vitro Inhibitor of OCT- and MATE-Mediated Transport of Metformin and Ethambutol

“…Treatment of TB requires long and intensive combination drug therapy, which can be complicated by the presence of concurrent diseases. The noncommunicable disease diabetes mellitus (DM) impacts TB with increasing magnitude (2,3). At the moment, an estimated 15% of TB cases can be attributed to DM (3).…”

“…Patients with DM have three times the risk of developing active TB compared to nondiabetics (3,4), probably because of impaired host defenses. In addition, patients with TB and DM show a worse response to TB treatment than patients with TB alone and thus face a higher risk of TB treatment failure, relapse after cure, and death (5).…”

Poređenje karakteristika plućne tuberkuloze kod bolesnika sa i bez dijabetesa

“…Promjene u životnom stilu, socioekonomski faktori, rast populacije i produžetak životnog vijeka uticali su na stalni porast broja oboljelih od dijabetesa naročito u zemljama sa nižim socioekonomskim statusom gdje je i tuberkuloza ozbiljan problem. Rizik od tuberkuloze je veći kod osoba koje koriste insulinsku terapiju, posebno kod onih koji primaju veće doze insulina [3]. U kliničkoj slici udruženog dijabetesa i tuberkuloze javljaju se simptomi i znaci koji su zajednički tim bolestima kao što su gubitak tjelesne mase, malaksalost itd.…”