Diabetes Mellitus and Tuberculosis | 17 Jul 2023

Source: TH

Why in News?

For a very long time, India has been experiencing the burden of two severe Epidemics, Diabetes Mellitus (DM) and Tuberculosis (TB), however few know how deeply these diseases are interlinked.

• Currently, India has around 74.2 million people living with diabetes while TB affects 2.6 million Indians every year.

How Are DM and TB Interlinked?

• Risk of Developing Respiratory Infections:
  • The DM increases the risk of developing respiratory infections. DM is a major risk factor that increases the incidence and severity of TB.
  • Among people with TB, the prevalence of DM was found to be 25.3% while 24.5% were pre-diabetic, in a 2012 study in tuberculosis units in Chennai.
• DM Hampers the Recovery of TB:
  • DM not only increases the risk of TB but also hampers the recovery process and prolongs the time for TB bacteria to be eliminated from the body.
  • The impaired cell-mediated immunity in DM affects the body's ability to fight infections, including TB.
• Alters the Defense Mechanism:
  • Uncontrolled DM alters the defense mechanisms in the lungs, making individuals more susceptible to TB infection.
  • Additionally, the altered functions of small blood vessels in the lungs and poor nutritional status, common in DM, create an environment that facilitates the invasion and establishment of TB bacteria.
• Likelihood of Unfavorable TB Treatment Outcomes:
  • DM increases the likelihood of unfavorable TB treatment outcomes, such as treatment failure, relapse/reinfection, and even death.
  • The coexistence of TB and DM in patients may also modify TB symptoms, radiological findings, treatment, final outcomes, and prognosis.
  • The dual burden of DM and TB not only impacts the health and survival of individuals but also places a significant burden on the healthcare system, families, and communities.

What can be done to Tackle Both DM and TB?

• Provide individualized care for TB and DM patients, integrating treatments and addressing comorbidities.
• Improve patient education, support, and nutrition to enhance TB treatment outcomes.
• Strengthen healthcare programs for TB and DM, build resilient and integrated health systems, and use research to inform evidence-based decision-making.

What is Diabetes Mellitus (DM)?

• About:
  • DM is a disorder in which the body does not produce enough or respond normally to insulin, causing blood sugar (glucose) levels to be abnormally high.
  • The name Diabetes Mellitus is often used rather than diabetes alone, to distinguish this disorder from Diabetes Insipidus.
    • Diabetes insipidus is a relatively rare disorder that does not affect blood glucose levels but, just like diabetes mellitus, causes increased urination.
  • While 70–110 mg/dL fasting blood glucose is considered normal, blood glucose levels between 100 and 125 mg/dL is considered prediabetes, and 126 mg/dL or higher is defined as diabetes.
• Types:
  • Type 1 Diabetes:
    • The body's immune system attacks the insulin-producing cells of the pancreas, and more than 90% of them are permanently destroyed.
    • The pancreas, therefore, produces little or no insulin.
    • Only about 5 to 10% of all people with diabetes have type 1 disease. Most people who have type 1 diabetes develop the disease before age 30, although it can develop later in life.
  • Type 2 Diabetes:
    • The pancreas often continues to produce insulin, sometimes even at higher-than-normal levels, especially early in the disease.
    • However, the body develops resistance to the effects of insulin, so there is not enough insulin to meet the body’s needs. As type 2 diabetes progresses, the insulin-producing ability of the pancreas decreases.
      • Type 2 diabetes was once rare in children and adolescents but has become more common. However, it usually begins in people older than 30 and becomes progressively more common with age.
      • About 26% of people older than 65 have type 2 diabetes.

What is Tuberculosis (TB)?

• Tuberculosis is an infectious disease that can cause infection in your lungs or other tissues.
• It commonly affects lungs, but it can also affect other organs like your spine, brain or kidneys.
• TB is caused by a bacterium called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but TB bacteria can attack any part of the body such as the kidney, spine, and brain.
• The three stages of TB are:
  • Primary infection.
  • Latent TB infection.
  • Active TB disease.