The Intersection Between Communicable And Chronic Diseases Especially With Respect To Tuberculosis And Diabetes

THE INTERSECTION BETWEEN COMMUNICABLE AND CHRONIC DISEASES ESPECIALLY WITH RESPECT TO TUBERCULOSIS AND DIABETES

Abstract

The link between diabetes mellitus and tuberculosis has been recognised for centuries. In recent decades, tuberculosis incidence has declined in high-income countries, but incidence remains high in countries that have high rates of infection with HIV, high prevalence of malnutrition and crowded living conditions, or poor tuberculosis control infrastructure. At the same time, diabetes mellitus prevalence is soaring globally, fuelled by obesity. There is growing evidence that diabetes mellitus is an important risk factor for tuberculosis and might affect disease presentation and treatment response. Furthermore, tuberculosis might induce glucose intolerance and worsen glycaemic control in people with diabetes. We review the epidemiology of the tuberculosis and diabetes epidemics, and provide a synopsis of the evidence for the role of diabetes mellitus in susceptibility to, clinical presentation of, and response to treatment for tuberculosis. In addition, we review potential mechanisms by which diabetes mellitus can cause tuberculosis, the effects of tuberculosis on diabetic control, and pharmacokinetic issues related to the co-management of diabetes and tuberculosis.

Introduction

The association between diabetes mellitus and tuberculosis and their synergistic role in causing human disease has been recognised for centuries. Ancient works by Yugimahamuni, an Indian siddhar, describe the symptoms of patients with “meganoikal” (urinary disorders), which progressed from obesity to impotence, thirst, and glycosuria, and ultimately, to unconsciousness or tuberculosis. The introduction of insulin in the 1920s, the discovery of streptomycin in the 1940s, and the subsequent development of other antibiotics substantially lowered case fatality rates for individuals with diabetes mellitus or tuberculosis. Improved sanitation, better nutrition, and less crowding led to markedly diminished tuberculosis incidence. In recent decades, tuberculosis has increasingly become a problem in low-income countries, particularly those with HIV epidemics, and non-insulin-dependent diabetes mellitus (NIDDM) has emerged as a growing worldwide chronic health condition, as a consequence of increases in obesity, changing patterns of diet and physical activity, and aging populations. The effect of diabetes on the development and severity of tuberculosis, and the complex interrelations between nutrition, obesity, diabetes, and tuberculosis remain provocative issues in public health and clinical medicine. In the setting of the increasing overlap of populations at risk for both diseases, the combination of tuberculosis and diabetes mellitus represents a worldwide health threat.

Our aim was to evaluate the published work and synthesise a concise Review of the following topics: the epidemiology of diabetes mellitus and tuberculosis disease; the effect of diabetes mellitus on tuberculosis incidence, radiographic presentation, severity, and outcomes; the potential mechanisms by which diabetes mellitus increases tuberculosis incidence; the cause–effect relation of tuberculosis on incident diabetes mellitus; and the pharmacological issues in cotreatment of tuberculosis and diabetes mellitus

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