Tuberculosis and diabetes mellitus: convergence of two epidemics

• Published in: The Lancet infectious diseases Vol. 9; no. 12; pp. 737 - 746
• Main Authors: Dooley, Kelly E, Chaisson, Richard E
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01.12.2009; Lancet Publishing Group; Elsevier Limited
• Subjects: Anti-Bacterial Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Convergence; Diabetes Complications - complications; Diabetes Complications - mortality; Diabetes Complications - physiopathology; Diabetes mellitus; Diabetes. Impaired glucose tolerance; Disease Outbreaks; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Epidemics; Epidemiology; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Global Health; Glucose tolerance; Human bacterial diseases; Human immunodeficiency virus; Humans; Hypoglycemic Agents - therapeutic use; Infection; Infectious Disease; Infectious diseases; Living conditions; Male; Malnutrition; Medical sciences; Mycobacterium; Obesity; Pharmacokinetics; Prevalence; Reviews; Risk factors; Tuberculosis; Tuberculosis - complications; Tuberculosis - mortality; Tuberculosis - physiopathology; Tuberculosis and atypical mycobacterial infections; Endocrinopathy; Infection; Epidemic; Tuberculosis; Diabetes mellitus; Bacteriosis; Mycobacterial infection
• ISSN: 1473-3099; 1474-4457; 1474-4457
• DOI: 10.1016/S1473-3099(09)70282-8

The link between diabetes mellitus and tuberculosis has been recognised for centuries. In recent decades, tuberculosis incidence has declined in high-income countries, but incidence remains high in countries that have high rates of infection with HIV, high prevalence of malnutrition and crowded living conditions, or poor tuberculosis control infrastructure. At the same time, diabetes mellitus prevalence is soaring globally, fuelled by obesity. There is growing evidence that diabetes mellitus is an important risk factor for tuberculosis and might affect disease presentation and treatment response. Furthermore, tuberculosis might induce glucose intolerance and worsen glycaemic control in people with diabetes. We review the epidemiology of the tuberculosis and diabetes epidemics, and provide a synopsis of the evidence for the role of diabetes mellitus in susceptibility to, clinical presentation of, and response to treatment for tuberculosis. In addition, we review potential mechanisms by which diabetes mellitus can cause tuberculosis, the effects of tuberculosis on diabetic control, and pharmacokinetic issues related to the co-management of diabetes and tuberculosis.