DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20195915

Vitamin D deficiency in patients with tuberculosis and its correlation with glycemic status

Ritu Karoli, Shobhit Shakya, Prem Shanker Singh

Abstract


Background: Comorbidity of diabetes and tuberculosis has serious health implications. Presence of diabetes at least three times increases the risk of tuberculosis which may be mediated by an abnormal innate immune response due to hyperglycaemia or low vitamin D levels.

Aim of the study- Present study was carried out to investigate whether lower serum 25(OH) D might be associated with higher prevalence of pulmonary or extra pulmonary tuberculosis which might provide an evidence for a role of vitamin D in the comorbidity of these two diseases and does it have any correlation with glycemic status.

Methods: In a hospital based cross sectional study, 264 patients with newly diagnosed tuberculosis were enrolled and according to glycemic status they were divided into three groups. They were assessed for vitamin D deficiency in addition to routine laboratory and biochemical parameters.

Results: The patients with diabetes had significantly lower vitamin D levels. The prevalence of severe vitamin D deficiency was highest in patients who had diabetes with tuberculosis. There was negative correlation between vitamin D levels and Hba1C and extensiveness of pulmonary tuberculosis

Conclusions: Serum vitamin D levels were significantly lower in tuberculosis patients with pre-diabetes and type 2 diabetes compared with those, who had normal glycemic status. We suggest that there is a need to pay more attention to vitamin D status in this country and if there is coexisting diabetes or impaired glucose intolerance, emphasis on vitamin D supplementation can be of utmost importance.


Keywords


Diabetes mellitus, Tuberculosis, Vitamin D

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References


Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes care. 2004;27(5):1047-53.

World Health Organization. Global tuberculosis control 2011.WHO/HTM/TB/2011.16. Geneva, Switzerland: WHO, 2011. World Health Organization. Available at: https://apps.who.int/iris/handle/10665/44728. Accessed 17th September 2019.

Stevenson CR, Forouhi NG, Roglic G, Williams BG, Lauer JA, Dye C, et al. Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence. BMC Pub Health. 2007;7(1):234.

Jeon CY, Murray MB. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med. 2008;5(7):e152.

Handel AE, Ramagopalan SV. Tuberculosis and diabetes mellitus: is vitamin D the missing link?. Lancet Inf Dis. 2010;10(9):596.

Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis. 2009;9(12):737-46.

Martineau AR. Old wine in new bottles: vitamin D in the treatment and prevention of tuberculosis. Proceedings Nutrit Soci. 2012;71(1):84-9.

Pilz S, Kienreich K, Rutters F, de Jongh R, van Ballegooijen AJ, Grübler M, et al. Role of vitamin D in the development of insulin resistance and type 2 diabetes. Current Diab Reports. 2013;13(2):261-70.

Chiu KC, Chu A, Go VL, Saad MF. Hypovitaminosis D is associated with insulin resistance and β cell dysfunction. Am J Clin Nutrition. 2004;79(5):820-5.

Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. Int J Epidemiol. 2008;37(1):113-9.

Holick MF. Vitamin D deficiency. New Engl J Med. 2007;357(3):266-81.

Mukati S, Julka A, Varudkar HG, Singapurwala M, Agrawat JC, Bhandari D, et al. A study of clinical profile of cases of MDR-TB and evaluation of challenges faced in initiation of second line Anti tuberculosis treatment for MDR-TB cases admitted in drug resistance tuberculosis center. Ind J Tuber. 2019;66(3):358-63.

Chang JT, Dou HY, Yen CL, Wu YH, Huang RM, Lin HJ, et al. Effect of type 2 diabetes mellitus on the clinical severity and treatment outcome in patients with pulmonary tuberculosis: a potential role in the emergence of multidrug-resistance. J Formosan Med Assoc. 2011;110(6):372-81.

Zittermann A. Vitamin D in preventive medicine: are we ignoring the evidence?. British J Nutrit. 2003;89(5):552-72.

Chesdachai S, Zughaier SM, Hao L, Kempker RR, Blumberg HM, Ziegler TR, et al. The effects of first-line anti-tuberculosis drugs on the actions of vitamin D in human macrophages. J Clin Translat Endocrinol. 2016;6:23-9.

Herrera MT, Gonzalez Y, Hernández-Sánchez F, Fabián-San Miguel G, Torres M. Low serum vitamin D levels in type 2 diabetes patients are associated with decreased mycobacterial activity. BMC Infect Dis. 2017;17(1):610.

Takiishi T, Gysemans C, Bouillon R, Mathieu C. Vitamion D and diabetes. Rhum Dis Clin North Am. 2012;38:179-206.

Pittas AG, Dawson-Hughes B. Vitamin D and diabetes. The J Steroid Biochem Mol Biol. 2010;121(1-2):425-9.

Hyppönen E, Läärä E, Reunanen A, Järvelin MR, Virtanen SM. Intake of vitamin D and risk of type 1 diabetes: a birth-cohort study. Lancet. 2001;358(9292):1500-3.

Zhan Y, Jiang L. Status of vitamin D, antimicrobial peptide cathelicidin and T helper‑associated cytokines in patients with diabetes mellitus and pulmonary tuberculosis. Exper herapeutic Med. 2015;9(1):11-6.

Zhao X, Yuan Y, Lin Y, Zhang T, Ma J, Kang W, et al. Vitamin D status in tuberculosis patients with diabetes, prediabetes and normal blood glucose in China: a cross-sectional study. BMJ Open. 2017;7(9):017557.

Chaudhary S, Thukral A, Tiwari S, Pratyush DD, Singh SK. Vitamin D status of patients with type 2 diabetes and sputum positive pulmonary tuberculosis. Ind J Endocrinol Metabol. 2013;17(3):S670.