Mycobacterium tuberculosis infection and diabetes mellitus-mycobacterium tuberculosis dual burden in subjects attending infectious diseases hospital Calabar, Nigeria


  • Raymond E. Eworo Department of Medical Laboratory Science, College of Medical Sciences, University of Calabar, Calabar, Nigeria
  • Zibril A. Okhormhe Department of Medical Laboratory Science, College of Medical Sciences, University of Calabar, Calabar, Nigeria
  • Ntamu A. Ntamu Department of Medical Laboratory Science, College of Medical Sciences, University of Calabar, Calabar, Nigeria
  • Kaiso-Umo S. Esiere Department of Medical Laboratory Science, College of Medical Sciences, University of Calabar, Calabar, Nigeria



Diabetes, Diabetes mellitus-tuberculosis dual burden, Tuberculosis


Background: The rising global DM epidemic is driving the problem of TB control. This research determined glycemic control in TB only infected and DM-TB comorbidity and the consequence of the double burden on treatment outcome.

Methods: fifty M. TB infected subjects and fifty control subjects were enrolled into the study, all the participants gave consents. FPG and HbA1c were determined by Colorimetry. Data were analyzed using SPSS version 20.0 statistical package, differences between groups and variation among groups were determined by Student’s t-test and ANOVA respectively while the association between variables by Pearson’s correlation. Differences were considered statistically significant at p<0.05.

Results: The mean FPG and HbA1c levels of TB subjects were significantly (P<0.05) higher than those of the control. The mean BMI of the TB infected subjects was significantly lower (p=0.001) than that of the controls. The mean age, FPG and HbA1c of TB subjects at the beginning phase of treatment were significantly lower (p<0.05) than those of subjects at the continuation phase of treatment. The mean age, FPG and HbA1c of subjects with DM-M.TB coexistence were significantly (p<0.05) higher than those of the M.TB only infected subjects. BMI of the DM-M.TB comorbidity subjects was lower than that of the M.TB only infected subjects (p=0.109). A significant positive correlation was obtained between HbA1C and FPG in M.tb infected subjects. (r=0.910, p=0.001). A negative correlation obtained between HbA1C and BMI in M.tb infected subjects. (r=0.267, p=0.061).

Conclusion: Infection with mycobacterium tuberculosis poses a risk to DM and vice versa, which may adversely affect treatment outcome and control of both diseases. Firm efforts to control DM may likely have a significant valuable effect on TB treatment outcome.


Tankeu T, Jean B, Nansseu R, Endomba A, Wafeu S, Arnaud K, et al. Global prevalence of diabetes mellitus in patients with tuberculosis: a systematic review and meta-analysis protocol. BMJ Open. 2017;7:e015170.

Tegegne S, Melkamu M, Teferra A, Awoke A, Tesfa H. Association between diabetes mellitus and multi-drug-resistant tuberculosis: evidence from a systematic review and meta-analysis. Sys Rev. 2018;7(1):161

Pal R, Ansari A, Hameed S, Zeeshan F. Diabetes Mellitus as Hub for Tuberculosis Infection: a Snapshot. Int J Chronic Dis. 2016;7.

Magee J, Kempker R, Kipiani M, Gandhi R, Darchia L, Tukvadze N, et al. Diabetes mellitus is associated with cavities, smear grade, and multidrug-resistant tuberculosis in Georgia. Int J Tubercul Lung Dis. 2015;6(19):685-92.

Baker A, Harries D, Jeon Y, Hart E, Kapur A, Lönnroth K, et al. The impact of diabetes on tuberculosis treatment outcomes: a systematic review. BMC Med. 2011;9(1):81.

Global Tuberculosis Report 2017, GENEVA- Global efforts to combat tuberculosis (TB), WHO/HTM/TB/2017.23,

Floyd K, Glaziou P, Zumla A, Raviglione M. The global tuberculosis epidemic and progress in care, prevention, and research: an overview in year 3 of the End TB era. Lancet Respir Med. 2018;6(4):299-314.

National Institute of Allergy and Infectious Diseases (NIAID) Strategic Plan for Tuberculosis Research 2018. Available at: Accessed 23 March 2019.

World Health Organization. WHO end TB strategy: global strategy and targets for tuberculosis prevention, care and control after 2015. Geneva: WHO;2015. Available at: post2015_strategy/en/. Accessed 30 April 2018.

Kyu H, Emilie M, Nathaniel H, Mumford E, Barber R, Chloe S et al. The global burden of tuberculosis: results from the Global Burden of Disease Study. 2018;(18)3,261-84.

Lönnroth K, Giovanni M, Ibrahim A, D'Ambrosio L, de Vries G, Diel R, et al. Towards tuberculosis elimination: an action framework for low-incidence countries. Europ Respir J. 2015Apr1;45(4):928-52.

Harries D, Ajay K, Satyanarayana S, Lin Y, Zachariah R, Lönnroth K, et al. Addressing diabetes mellitus as part of the strategy for ending TB. Transactions Royal Soc Trop Med Hygiene. 2016;110:173-9.

Marais BJ, Loennroth K, Lawn SD, Migliori GB, Mwaba P, Glaziou P, et al. Tuberculosis comorbidity with communicable and non-communicable diseases: integrating health services and control efforts. Lancet Infectious Dis. 2013 May 1;13(5):436-48.

Jeon Y, Harries D, Baker A, Hart E, Kapur A, Lönnroth K, et al. Bi-directional screening for tuberculosis and diabetes: a systematic review. Trop Med Int Heal. 2010;15(11):1300-14.

Riza L, Pearson F, Ugarte-Gil C, Alisjahbana B, van de Vijver S, Panduru M, et al. Clinical management of concurrent diabetes and tuberculosis and the implications for patient services. Lancet Diabetes Endocrinol. 2014;2(9):740-53,

USAID Health-Related Research and Development Progress Report, Report to Congress; 2013.25-7.

Lin Y, Li L, Mi F, Du J, Dong Y, Li Z, et al. Screening patients with diabetes mellitus for tuberculosis in China. Trop Med Int Heal. 2012;17(10):1302-8.

International Diabetes Federation (IDF). Diabetes atlas. 7th Ed. Brussels: International Diabetes Federation; 2015. Available at: Accessed 23 March 2019.

Cho H, Shaw E, Karuranga S, Huang Y, da Rocha D, Ohlrogge W, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018; 138:271-81.

Lönnroth K, Roglic G, Harries D. Improving tuberculosis prevention and care through addressing the global diabetes epidemic: from evidence to policy and practice. Lancet Diab Endocrinol. 2014;2:10.

Schepisi SM, Navarra A, Altet Gomez MN, Dudnyk A, Dyrhol-Riise AM, Esteban J, et al. Burden and Characteristics of the Comorbidity Tuberculosis-Diabetes in Europe: TB net Prevalence Survey and Case-Control Study. Open Forum Infectious Dis. 2018:6(1)ofy337S.

Critchley A, Restrepo I, Ronacher K, Kapur A, Bremer A, Schlesinger S, et al. Defining a research agenda to address the converging epidemics of tuberculosis and diabetes epidemiology and clinical management. Chest. 2017;152(1),165-73.

Lee H, Fu H, Lee R, Magee M, Lin H. Tuberculosis and diabetes in low and moderate tuberculosis incidence countries. Int J Tuberc Lung Dis. 2018;22:7-16.

Siddiqui AN, Khayyam KU, Sharma M. Effect of diabetes mellitus on tuberculosis treatment outcome and adverse reactions in patients receiving directly observed treatment strategy in India: a prospective study. BioMed Res Int. 2016;11.

Restrepo BI. Diabetes and Tuberculosis. Microbiol Spectr. 2016;4(6):10.

Fisher-Hock, P. Worldwide increase in diabetes: Implications for tuberculosis control. Res Rep Trop Med. 2014:5;35-44.

Zheng C, Minhui H, Gao F. Diabetes and pulmonary tuberculosis: a global overview with special focus on the situation in Asian countries with high TB-DM burden. Glob Heal Action. 2017;10(1):1264702.

Chang T, Dou Y, Yen L, Wu H, Huang M, Lin J, et al. Effect of type II diabetes mellitus on the clinical severity and treatment outcome in patients with pulmonary tuberculosis. A potential role in the emergence of multidrug-resistance. J Formos Med Assoc. 2011;110(6):372-81.

Girardi E, Schepisi MS, Goletti D, Bates M, Mwaba P, Yeboah-Manud D, et al. The global dynamics of diabetes and tuberculosis: the impact of migration and policy implications Intern. J Infectious Diseases. 2017;56:45-53.

Shen C, Lin L, Wei C, Liao C, Chen C, Chen H, et al. Increased Risk of Tuberculosis in Patients With Type 1 Diabetes Mellitus: Results From a Population-Based Cohort Study in Taiwan, Medicine (Baltimore). 2014Oct;93(16):e96.

Khare K, Vivek K. The double burden of tuberculosis and diabetes prevalence of diabetes mellitus in tuberculosis. Int J Adv Med. 2018Feb;5(1):115-9.

Ruslami R, Aarnoutse RE, Alisjahbana B, van der Ven J, van Crevel R. Implications of the global increase of diabetes for tuberculosis control and patient care. Trop Med Inter Heal. 2010;15(11):1289-99.

World Health Organization & International Union against Tuberculosis and Lung Disease. Collaborative framework for care and control of tuberculosis and diabetes. Geneva: World Health Organization. WHO/HTM/TB/2011.15 ix, 40p Available at:

Jeon Y, Murray B, Baker A. Managing tuberculosis in patients with diabetes mellitus: why we care and what we know. Expert Rev. Anti Infect Ther. 2012; 10(8):863-8.

Li L, Lin Y, Mi F, Tan S, Liang B, Guo C, et al. Screening patients with tuberculosis for diabetes mellitus in China. Trop Med Int Health. 2012; 17(10):1294-1301.

Sulaiman A, Khan H, Muttalif R, Hassali A, Ahmad N, Iqubal S. Impact of diabetes mellitus on treatment outcomes of tuberculosis patients in tertiary care setup. Am J Med Sci. 2013; 345(4):321-5.

Workneh H, Bjune A, Yimer A. Prevalence and associated factors of diabetes mellitus among tuberculosis patients in South- Eastern Amhara Region, Ethiopia: a cross-sectional study. PLoSONE. 2016;11(1):e0147621.

Tiroro S. The magnitude and associated factors of tuberculosis among diabetic patients at Tikur Anbessa Specialist Teaching Hospital in Addis Ababa, Ethiopia. 2015. Available at:

Sherry M, Evan S. Malnutrition and Associated Disorders in Tuberculosis and Its Therapy.

Accessed 29 Jun 2018.

Wang Q, Ma A, Han X, Zhao S, Cai J, Ma Y, et al. Prevalence of type 2 diabetes among newly detected pulmonary tuberculosis patients in China: A community based Cohort study. PLoS ONE. 2013; 8(12):e82660.

Viswanathan V, Kumpatla S, Aravindalochanan V, Rajan R, Chinnasamy C, Srinivasan R, Prevalence of diabetes and pre-diabetes and associated risk factors among tuberculosis patients in India. PLoS One. 2012;7(7):e41367.




How to Cite

Eworo, R. E., Okhormhe, Z. A., Ntamu, N. A., & Esiere, K.-U. S. (2019). Mycobacterium tuberculosis infection and diabetes mellitus-mycobacterium tuberculosis dual burden in subjects attending infectious diseases hospital Calabar, Nigeria. International Journal of Research in Medical Sciences, 7(8), 3155–3161.



Original Research Articles