Tuberculosis-Related Diabetes: Is It Reversible after Complete Treatment?

Abstract

Individuals with newly diagnosed tuberculosis (TB) were screened for diabetes (DM) with fasting plasma glucose (FPG) in Pakistan. A significant decrease in FPG was observed when TB was treated. Of those with newly diagnosed DM, 46% and 62% no longer had hyperglycemia after 3 and 6 months, respectively. Individuals with known DM also showed a significant decrease in fasting plasma levels when treated for TB, but after 3 months none had normoglycemia, and after 6 months 9.2% were normoglycemic. Thus, TB-related DM may abate when the stress terminates, as is the case in gestational DM. However, because stress hyperglycemia may be associated with subsequent risk of developing DM, follow-up is recommended.

Stress Hyperglycemia in Patients with Tuberculosis Disease: Epidemiology and Clinical Implications

“…For example, studies from Iran [16], Pakistan [17], and Tanzania [18] reported >50% of patients with TB and newly diagnosed hyperglycemia reverted blood glucose levels to normal after 3 or 6-months of TB treatment. In contrast, a 2017 study among Chinese patients with TB without previously diagnosed diabetes reported that 80% (16/20) of patients who had initial hyperglycemia (fasting blood glucose [FBG] >110 mg/dL) remained hyperglycemic after 6-months of TB treatment [19].…”

“…In some patients, stress hyperglycemia resulting from TB disease may accelerate or advance the progression from normoglycemia toward pre-diabetes or diabetes. Limited data suggest that for the majority of patients with TB disease and stress hyperglycemia, glucose levels reduce or return to normal during TB treatment or post TB treatment [17, 18, 66]. However, whether stress hyperglycemia during TB disease is an independent risk factor for incident pre-diabetes or diabetes post TB treatment remains unclear.…”

“…The few studies that measured blood glucose levels at the start of TB treatment and again at follow-up visits during or at the end of TB treatment reported a general decrease in prevalence and severity of hyperglycemia during the course of TB treatment. For example, studies from Iran [16], Pakistan [17], and Tanzania [18] reported >50% of patients with TB and newly diagnosed hyperglycemia reverted blood glucose levels to normal after 3 or 6-months of TB treatment. In contrast, a 2017 study among Chinese patients with TB without previously diagnosed diabetes reported that 80% (16/20) of patients who had initial hyperglycemia (fasting blood glucose [FBG] >110 mg/dL) remained hyperglycemic after 6-months of TB treatment [19].…”

Convergence of non-communicable diseases and tuberculosis: a two-way street?

“…A 2017 study of patients with smear positive TB from Pakistan reported a median decrease in fasting blood glucose after 6 months of TB treatment among patients with newly screened diabetes (median decrease 38 mg/dl) and known diabetes (median decrease 31 mg/dl). 25 In the Effects of Diabetes on Tuberculosis Severity (EDOTS) cohort, one third of particpants with diabetic range hyperglycemia at baseline were unaware of having diabetes prior to incident TB. 21 This “new-DM” group had lower median HbA1c at baseline than those with diabetes diagnosed prior to incident TB and many reverted to pre-diabetic range hyperglycemia after the intensive phase of TB treatment.…”

“…One plausible mechanism by which active TB may induce hyperglycemia or diabetes is via an acute stress response resulting from an interaction between pro-inflammatory cytokines and regulatory hormones, which may be sufficient to disrupt insulin signaling and increase insulin resistance. 25,32–34 Active TB results in an increased production of reactive oxidative species and increased expression of pro-inflammatory cytokines which may lead to excess production of glucose in the liver, which in turn can result in stress hyperglycemia. 25 Consequently, ongoing inflammation and stress responses 35 during the acute phase of TB likely results in increased blood glucose levels and hyperglycemia.…”