HYPERGLYCEMIA IN TUBERCULOSIS. IS IT STRESS INDUCED OR TRUE DIABETES MELLITUS.

Abstract

The worldwide increase in the prevalence of diabetes has been most notable in TB-endemic countries and has led to the re-emerging importance of the association between these two diseases. Today, type 2 diabetes is one of the most prevalent co morbidities and risk factors in TB patients, along with under nutrition and HIV/AIDS. However, it is striking how little we know about the underlying biology of the association between TB and diabetes. Diabetes increases tuberculosis risk, while tuberculosis, as an infectious disease leads to hyperglycemia.  The metabolic alterations characteristics of diabetes (e.g., chronic hyperglycemia, metabolic inflammation [meta-inflammation], oxidative stress) are likely to contribute to the immune dysfunction to mycobacterium. The discovery of these mechanisms is providing the knowledge base to design host-directed therapies for TB patients with diabetes, and perhaps those without diabetes as well.

METHODOLOGY:

A total of 112 patients, newly diagnosed as having pulmonary tuberculosis, in the department of pulmonary medicine, Alluri Sitaramaraju academy of Medical sciences, Eluru during Nov’2018 and October’2019 were taken into consideration.  88 patients met with inclusion criteria were included in the study. The RBS levels and HbA1c levels were taken before initiating the anti-tubercular therapy (ATT). Patients with HbA1c < 7% and with RBS > 140mg/dl were followed up with sugar levels and diet advice.HbA1c and RBS were repeated at the end of 2 months of intensive phase to see if the high RBS persisted.

RESULTS:

•  112 patients were diagnosed with TB during this period. Of these 24 were already under treatment of Diabetes Mellitus  and were hence excluded from the study
• Of the remaining 88 patients , 60 patients had RBS >140mg/dl and HbA1c <7% and were included and followed up for regular blood sugar levels monthly and HbA1c after 2 months
• During follow up 44 patients had blood sugar levels below 140mg/dl, after 2 months of ATT and HbA1c continued to be < 7
• 16 patients had high blood sugar levels above 140mg/dl and 3 among them had elevated HbA1c levels as well . All these patients had to be started on OHA

CONCLUSION: 

1. 68% of patients with no previous history of diabetes mellitus were found to have high blood sugar levels at the start of the study
2. 73% of the patients with high blood sugar levels came back to normal levels within 2 months of treatment
3. Only 4 patients (26%)had persistent high blood sugar levels who required treatment with OHA(oral hypoglycaemic agents)