Impact of diabetes mellitus on clinical presentation and treatment response of smear positive pulmonary tuberculosis patients

Abdul Hashim K. P., Muhammed Anas Ayoob


Background: Diabetes mellitus (DM) is a known risk factor for tuberculosis (TB). The aim of this study was to evaluate the effect of DM on clinical presentation and treatment response of sputum positive pulmonary tuberculosis patients.

Methods: The present retrospective study was carried out in department of Pulmonary Medicine, Sree Gokulam Medical College and Research Foundation, Trivandrum, between January 2014 to December 2016.

Results: Out of 205 subjects enrolled for this study, 73 were diagnosed with DM and 132 patients had no history of DM and were having HbA1c less than 6.5%. Mean HbA1c in DM group at presentation was 10.5 and in patients without DM group was 5.6. Low BMI was more in DM patients. Clinical characteristics at presentation were similar in both the groups. Patients with DM presented after long duration of symptoms (>8 weeks duration) and also with more atypical symptoms. On radiological examination, lower zone involvement and cavity lesions were more in patients with DM which was statistically significant. Clinical picture at the end of 6 months showed improvement in both the groups but radiological improvement was more in patients without DM compared to the other group.

Conclusions: Uncontrolled DM is associated with high prevalence of Tuberculosis. Atypical symptoms and atypical radiological findings are more common in DM patients which lead to delayed presentation. Strategies are needed to ensure that optimal care is provided to patients with both diseases.



Pulmonary tuberculosis, Diabetes mellitus

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Global Tuberculosis Report. World Health Organization: Geneva, Switzerland. 2014.

Van den Brande P. Revised guidelines for the diagnosis and control of tuberculosis: impact on management in the elderly. Drugs Aging. 2005;22:663-86.

Harries AD, Lin Y, Satyanarayana S, Lönnroth K, Li L, Wilson N, et al. The looming epidemic of diabetes- associated tuberculosis: learning lessons from HIV-associated tuberculosis. Int J Tuberc Lung Dis. 2011;15:1436-44.

Fazeli Farsani S, van der Aa MP, van der Vorst MM, Knibbe CA, de Boer A. Global trends in the incidence and prevalence of type 2 diabetes in children and adolescents: a systematic review and evaluation of methodological approaches. Diabetologia. 2013;56:1471-88.

Raviglione M, Marais B, Floyd K. Scaling up interventions to achieve global tuberculosis control: progress and new developments. Lancet. 2012;379:1902-13.

International Diabetes Federation Diabetes Atlas. Available at:

Harries AD, Murray MB, Jeon CY, Ottmani SE, Lonnroth K, et al. Defining the research agenda to reduce the joint burden of disease from diabetes mellitus and tuberculosis. Trop Med Int Health. 2010;15:659-63.

Kim SJ, Hong YP, Lew WJ, Yang SC, Lee EG. Incidence of pulmonary tuberculosis among diabetics. Tuber Lung Dis. 1995;76:529-33.

Jabbar A, Hussein SF, Khan AA. Clinical characteristics of pulmonary tuberculosis in adult Pakistani patients with coexisting diabetes mellitus. East Mediterr Health J. 2006;12:522-27.

Patel JC, De Souza C, Jigjini SS. Diabetes and tuberculosis. Ind J Tub. 1977;24:155-8.

Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: A systematic review of 13 observational studies. PLoS Med. 2008;5:e152.

Leung CC, Lam TH, Chan WM, Yew WW, Ho KS, Leung GM, et al. Diabetic control and risk of tuberculosis: A cohort study. Am J Epidemiol. 2008;167:1486-94.

Rawat J, Sindhwani G, Biswas D. Effect of age on presentation with diabetes: Comparison of nondiabetic patients with new smear-positive pulmonary tuberculosis patients. Lung India. 2011;28:187-90.

Screening of Tuberculosis Patients for Diabetes Mellitus: Pilot Project-,Module for RNTCP staff 2009. Central TB Division, MOH&FW, New Delhi

Singla R, Khan N, Al-Sharif N, Al-Sayegh MO, Shaikh MA, Osman MM. Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients. Int J Tuberc Lung Dis. 2006;10:74-9.

Balakrishnan S, Vijayan S, Nair S, Subramoniapillai J, Mrithyunjayan S, Wilson N, et al. High diabetes prevalence among tuberculosis cases in Kerala, India. PLoS One. 2012;7:e46502.

Li L, Lin Y, Mi F, Tan S, Liang B, Guo C, et al. Screening of patients with tuberculosis for diabetes mellitus in China. Trop Med Int Health. 2012;17:1294-301.

Alisjahbana B, Sahiratmadja E, Nelwan EJ, Purwa AM, Ahmad Y, Ottenhoff TH, et al. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin Infect Dis. 2007;45:428-35.

Jain MK, Baghel PK, Agrawal R. Study of impaired glucose tolerance in pulmonary tuberculosis. Indian J Community Med. 2006;31(3):137-9.

Qazi MA SN, Warraich MM, Imran A, Haque IU, Attique MUH, et al. Radiological Pattern of Pulmonary Tuberculosis in Diabetes Mellitus. Ann Intern Med. 2009;15(2).

Shaikh MA, Singla R, Khan NB, Sharif NS, Saigh MO. Does diabetes alter the radiological presentation of pulmonary tuberculosis? Saudi Med J. 2003;24(3):278-81.

Wang JY, Lee LN, Hsueh PR. Factors changing the manifestation of pulmonary tuberculosis. Int J Tuberc Lung Dis. 2005;9(7):777-83.

Carreira S, Costeira J, Gomes C, André JM, Diogo N. Impact of diabetes on the presenting features of tuberculosis in hospitalized patients. Rev Port Pneumol. 2012;8(5):239-43.