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.

• Authors: Anca Lelia Riza, Fiona Pearson, Cesar Ugarte-Gil, Bachti Alisjahbana, Steven van de Vijver, Nicolae M Panduru, Philip C Hill, Rovina Ruslami, David Moore, Rob Aarnoutse, Julia A Critchley, Reinout van Crevel
• Journal: The lancet. Diabetes & endocrinology (Lancet Diabetes Endocrinol) Vol. 2 Issue 9 Pg. 740-53 (Sep 2014) ISSN: 2213-8595 [Electronic] England
• PMID: 25194887 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review)
• Copyright: Copyright © 2014 Elsevier Ltd. All rights reserved.

Chemical References

• Antitubercular Agents
• Blood Glucose

Topics

• AIDS-Related Opportunistic Infections (drug therapy, epidemiology, immunology)
• Antitubercular Agents (administration & dosage)
• Blood Glucose
• Chemoprevention (methods)
• Diabetes Mellitus, Type 2 (drug therapy, epidemiology, immunology)
• Drug Interactions
• Global Health
• HIV Infections (drug therapy, epidemiology, immunology)
• HIV-1 (isolation & purification)
• Humans
• Immunocompromised Host
• Prognosis
• Tuberculosis, Pulmonary (drug therapy, epidemiology, immunology)