- People attending TB clinics should be screened for diabetes and those attending diabetes clinics should be screened for TB if presenting with symptoms.
- Diabetes may be associated with delayed sputum conversion (>60 days), higher probability of tuberculosis treatment failure, higher recurrence and relapse rates, higher overall mortality, higher rates of multi-drug resistance TB and more atypical presentation in hyperosmolar hyperglycemic nonketotic coma or ketoacidosis.
- For both conditions, controlling blood sugar, being more physically active, avoiding chronic stress, getting enough sleep and maintaining ideal weight are recommended.
Review Drug Requirements
- Rifampicin is a potent hepatic enzyme-inducing agent, accelerates the metabolism of oral hypoglycemic agents and shortens the plasma half-life of sulphonylureas
- Isoniazid antagonizes sulphonylureas, impairs insulin release and action and leads to increased requirement of insulin and oral antidiabetic medication
- Therefore people with diabetes may require an increase in dosage of antidiabetic medication if they develop tuberculosis
Use Oral Antidiabetic Medicines Carefully in Tuberculosis
People with diabetes mellitus and tuberculosis should be treated with insulin injection, or in case a diabetic with tuberculosis is on oral hypoglycemic agents, it may be necessary to switch to insulin.
- Tuberculosis affects both the liver and pancreas: oral antidiabetic drugs are contraindicated in hepatic disease, which is a common adverse effect of antituberculous therapy.
- Metformin produces weight loss, particularly in high doses, and it is also an anorectic.
- Marked weight loss and higher insulin and caloric needs in tuberculosis are other important indications for reviewing oral antidiabetic therapy in diabetes mellitus.