TB and Diabetes comorbidity

The recent medical evidence on the interactions between TB and diabetes has shown the following:
• About 10% of TB cases globally are linked to diabetes. 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. People with diabetes have a two to three times higher risk of getting infected with TB, compared to people without diabetes.
• A large proportion of people with diabetes as well as TB remain undiagnosed, or are diagnosed at a late stage. Due to lack of early detection and treatment, complications from TB–diabetes co-morbidity lead to high cost on treatment and out-of-pocket expenditure. Early detection can help improve care and control of both diseases.
• Diabetes can lengthen the time for sputum culture conversion. Theoretically, this could lead to the development of drug resistance if a 4-drug regimen in the intensive phase of therapy is changed to a 2-drug regimen in the presence of culture-positive TB.
• People with TB and coexisting diabetes have a four times higher risk of death during TB treatment and higher risk of TB relapse after treatment. WHO recommended TB treatments should be rigorously implemented for people with TB–diabetes co-morbidity.
• Diabetes is complicated by the presence of infectious diseases, including TB. It is important that proper care for diabetes be provided to patients suffering from TB–diabetes co-morbidity.
• TB is associated with worsening glycaemic control in people with diabetes. It has been argued that good glycemic control in TB patients can improve
treatment outcomes.
The precise biological mechanisms that result in this interaction between diabetes and TB are still not clear. Epidemiological models have shown that diabetes accounts for 20% of smear-positive pulmonary TB10 and recent analyses have indicated that the increase in diabetes prevalence in India has been an important obstacle to reducing TB incidence in the country.