Diabetics, beware of TB

The incidence of diabetes mellitus is a new challenge for those dealing with tuberculosis. Likewise, with lower immunity levels, diabetics easily fall prey to TB, and the combination is rather deadly, observes  Dr Kailashnath Gupta .

The prevalence of tuberculosis (TB), one of the world's deadliest diseases, has been a major health concern in India for centuries. According to the Union Health Ministry, 40 percent of Indians are affected with TB. In 2010, an estimated 2.3 million TB cases occurred, while 3,60,000 patients died of the condition, with about 1000 deaths per day. World Health Organisation (WHO) reports that, of the 1.5 million who die from TB annually, majority are from the developing countries, owing to malnutrition, crowded living conditions and poor TB control infrastructure.

Tuberculosis & diabetes

The incidence of diabetes mellitus is a new challenge for those dealing with tuberculosis. The co-existence of these two diseases can be seen as a convergence of two imminent epidemics, especially in developing countries like India. Obesity is the major risk factor for the increased incidences of diabetes mellitus. People with a weak immune system, as a result of chronic diseases, such as diabetes, are at a higher risk of progressing from latent to active TB. About 10 percent of TB cases, globally, are linked to diabetes. A large proportion of people with diabetes as well as TB is not diagnosed or is diagnosed too late. In India, undiagnosed and mistreated cases of TB continue to drive the grave scenario. Early detection can help improve care and control of both diseases.

Circle of problems

Now the question is that if diabetes can predispose a patient to TB, can TB infection lead to diabetes mellitus? 

Infections, including TB, often worsen glycaemic control in diabetic patients, and poorly controlled diabetes might in turn augment the severity of infections. Diabetes is complicated by the presence of infectious diseases, including TB. TB might induce glucose intolerance and worsen glycaemic control in people with diabetes. It is important that proper care for diabetes is provided to those that are suffering from TB. 

Treatment & complications

WHO reports propose diabetes screening for all people with TB. Hence, screening for TB in people with diabetes, in countries like India, should be made compulsory. People with diabetes, who are diagnosed with TB, have a higher risk of death during TB treatment. Those with Type 2 diabetes who have chronic, high, uncontrolled blood sugar levels have altered immune response to TB. Also, those who have co-existing diabetes and tuberculosis take longer to respond to anti-tubercular treatment.  Such patients respond slowly to drugs and it hinders the treatment of the disease. It may even be deadly, if the person has drug resistance. Such patients are also at high risk of TB relapse after treatment, and Multi Drug Resistant Tuberculosis (MDR-TB). 

Preventing TB in a diabetic

n Ensure good control of blood sugar. The risk of tuberculosis increases when persistent hyperglycemia is present. 

n As pulmonary TB is contracted through droplet infection by airborne germs expelled by the infected person coughing or sneezing, it is difficult to control spread. This is why diabetics should avoid congested places and places with poor ventilation as much as possible. 

n A diabetic with chronic cough should be investigated for TB, especially if the person is living in proximity to a person with pulmonary tuberculosis. 

A diabetic is also prone to developing TB in other organs, like intestines, abdominal lymph nodes or the more serious tubercular meningitis. 
(The writer is a consultant pulmonologist at Columbia Asia Hospital, Gurgaon)

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