Clinical management of concurrent diabetes and tuberculosis and the implications for patient services

Anca Lelia Riza, Fiona Pearson, Cesar Ugarte-Gil, Bachti Alisjahbana, Steven Van de Vijver, Nicolae M. Panduru, Philip C. Hill, Rovina Ruslami, David Moore, Rob Aarnoutse, Julia A. Critchley, Reinout van Crevel

Research output: Contribution to journalReview articlepeer-review

Abstract

Diabetes triples the risk for active tuberculosis, thus the increasing burden of type 2 diabetes will help to sustain the present tuberculosis epidemic. Recommendations have been made for bidirectional screening, but evidence is scarce about the performance of specific tuberculosis tests in individuals with diabetes, specific diabetes tests in patients with tuberculosis, and screening and preventive therapy for latent tuberculosis infections in individuals with diabetes. Clinical management of patients with both diseases can be difficult. Tuberculosis patients with diabetes have a lower concentration of tuberculosis drugs and a higher risk of drug toxicity than tuberculosis patients without diabetes. Good glycaemic control, which reduces long-term diabetes complications and could also improve tuberculosis treatment outcomes, is hampered by chronic inflammation, drug-drug interactions, suboptimum adherence to drug treatments, and other factors. Besides drug treatments for tuberculosis and diabetes, other interventions, such as education, intensive monitoring, and lifestyle interventions, might be needed, especially for patients with newly diagnosed diabetes or those who need insulin. From a health systems point of view, delivery of optimum care and integration of services for tuberculosis and diabetes is a huge challenge in many countries. Experience from the combined tuberculosis and HIV/AIDS epidemic could serve as an example, but more studies are needed that include economic assessments of recommended screening and systems to manage concurrent tuberculosis and diabetes.

Original languageEnglish (US)
Pages (from-to)740-753
Number of pages14
JournalThe Lancet Diabetes and Endocrinology
Volume2
Issue number9
DOIs
StatePublished - Sep 1 2014
Externally publishedYes

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Fingerprint

Dive into the research topics of 'Clinical management of concurrent diabetes and tuberculosis and the implications for patient services'. Together they form a unique fingerprint.

Cite this