Diabetes and pulmonary tuberculosis: a global overview with special focus on the situation in Asian countries with high TB-DM burden

Abstract

Background: The double burden of tuberculosis (TB) and diabetes mellitus (DM) is hitting certain Asian countries harder than other areas. In a global estimate, 15% of all TB cases could be attributable to DM, with 40% of those cases coming from India and China. Many other countries of South, East, and South-East Asia are of particular concern given their TB burdens, large projected increases in DM prevalence, and population size. Objective: In this narrative review, we aimed to: (i) give an overall insight into the evidence on TB-DM epidemiology from high double burden Asian countries, (ii) present the evidence on bi-directional screening implementation in this region, (iii) discuss possible factors related to higher TB susceptibility of Asian diabetic patients, and (iv) identify TB-DM comorbidity treatment challenges. Methods: The PubMed and Google Scholar databases were searched for all studies addressing DM/TB epidemiology, bi-directional screening and management in South, East and South-East Asia. Results: We identified the DM prevalences among TB patients as ranging from approximately 5% to more than 50%, whereas TB prevalences among diabetic patients were 1.8–9.5 times higher than in the general population in developing Asian countries. Evidence from studies designed to address diagnosis and treatment of the dual disease in these critical regions is scarce as well as the evidence related to possible DM patients’ genetic and acquired predisposition for TB. Conclusion: More prospective studies specifically designed to address adequate screening techniques, identify patients at risk, and define an adequate treatment of dual disease in this region are needed without delay.

Elevated circulating levels of monocyte activation markers among tuberculosis patients with diabetes co‐morbidity

“…Diabetes mellitus is one of the most important risk factors in the worsening of TB and triples the risk of developing active TB disease . Now, approximately 15% of global TB cases can be attributed to DM co‐morbidity . Clinically, DM increases TB severity and worsens TB treatment outcomes, while equally TB hampers glycemic control .…”

Tuberculosis and Diabetes Mellitus- Not a Sweet Association!

“…[13] Proportion of DM in different Age Groups of Pulmonary TB Patients This study shows that proportion of patients with DM is high among older age groups. Zheng C et al [14] shows that median age of patients with TB-DM is 49.5 +-11.8, p-value= 0.001. Wang Q et al [15] also shows high proportion of DM as age increases.…”

Diabetes mellitus and tuberculosis—a double whammy

“…So also, India accounts for a significant proportion of cases of tuberculosis in the world. It is also estimated that the highest number of cases of tuberculosis associated with diabetes are reported from India and a large proportion of diabetic patients in our country suffer from tuberculosis [2][3][4]. This suggests a huge double burden of diabetes and tuberculosis in our country.…”