Introduction: Tuberculosis (TB) remains to be a major cause of morbidity and mortality throughout the world. The link of Diabetes (DM) and TB is more prominent in developing countries and the higher susceptibility of tuberculosis in diabetics may be related to a longer duration of disease or due to poor glycemic control.

Aims: To study the effect of glycemic control on radiographic presentation of pulmonary Tuberculosis in Diabetics.

Methodology: It”s a prospective cross sectional study. Patients above 18 years, having Pulmonary Tuberculosis with Diabetis Mellitus were included.

Pulmonary Tuberculosis with other immunocompromised conditions like HIV, Chronic kidney disease, Malignancy, Long term steroids, Immunosuppressive drugs were excluded.

Glycemic control was assessed by glycated haemoglobin (HbA₁C)<7 as controlled >7 as uncontrolled. Demographic, Clinical and Radiographic parameters were studied in respect to their glycemic control.

Results: There were 200 tuberculosis patients, 88 were diabetic, with 44%prevalence. The mean age was 52.13+10.93; 52%were males, mean HbA₁C was 9.04±1.70; 93.2%had uncontrolled glycemic status.78(59.0%) had lower lung field abnormalities;mean HbA₁C 8.87, 39(29.5%)had upper lung field; HbA₁C 9.25 and 11.3%both lung fields; HbA₁C 9.36. 108(81.8%)had nodular infiltrative lesions, 18(13.6%)had cavities; HbA₁C 9.88. 83.3%had cavities in lower lung fields.

Conclusion: Prevalence of Diabetes among Pulmonary Tuberculosis is in the rise with uncontrolled diabetic patients predominantly affected. Lower lung field involvement with atypical radiographic presentations are more common in patients with diabetes. Patients with poor glycaemic control demonstrated cavitary lesions more than their counterparts but has no significant effect on zonal distribution of the radiographic lesion.

Key Words: Pulmonary Tuberculosis, Diabetes Mellitus, Glycemic control, Glycated Haemoglobin, HbA₁C,

1. Global TB report 2016
2. Ruslami R, Aarnoutse RE, Alisjahbana B, van der Ven AJ, Van Crevel R: Implications of the global increase of diabetes for tuberculosis control and patient care. Trop Med Int Health 2010, 15(11):1289–1299.
3. Global report on diabetes.World Health Organization, Geneva, 2016.
4. International Diabetes Federation: IDF diabetes atlas. 4th edition. Brussels, Belg-ium: International Diabetes Federation; 2009.
5. Sidibe EH: Main complications of diabetes mellitus in Africa. Ann Med Interne (Paris)2000, 151(8): 624–628.02(2): 539- 41
6. 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.
7. Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis. 2009;9(12):737–46.
8. Webb EA, Hesseling AC, Schaaf HS, Gie RP, Lombard CJ, Spitaels A, Delport S, Marais BJ, Donald K, Hindmarsh P, Beyers N: High prevalence of mycobacterium tuberculosis infection and disease in children and adolescents with type 1 diabetes mellitus. Int J Tuberc Lung Dis 2009, 13(7):868–874.
9. Dobler CC, Flack JR, Marks GB: Risk of tuberculosis among people with Diabetes mellitus: an Australian nationwide cohort study.BMJ Open 2012, 2(1):e000666.
10. Leung CC, Lam TH, Chan WM, Yew WW, Ho KS, Leung GM, Law WS, Tam CM, Chan CK, Chang KC: Diabetic control and risk of tuberculosis: a cohort study. Am J Epidemiol 2008, 167(12): 1486–149
11. Jagadish Rawat et al : effect of age on presentation with diabetes: comparison of non diabetic patients with new smear –positive pulmonary tuberculosis patients: Lung India.
12. Hiwot Amare1*, Aschalew Gelaw2 etal Smear positive pulmonary tuberculosis among diabetic patients at the Dessie referral hospital, Northeast Ethiopia , Infectious Diseases of poverty 2013, 2:6)
13. Hardy Kornfeld, MD; Kim West, BS etal Diabetes in TB patients from South India: A Report from the Effects of Diabetes on Tuberculosis Severity (EDOTS) Study: chest 2016,(): doi:10. 1016/j. chest. 2016.02.675
14. Park SW, Shin JW, Kim JY, Park IW, Choi BW, Choi JC, Kim YS: The effect of diabetic control status on the clinical features of pulmonary tuberculosis. Eur J Clin Microbiol Infect Dis 2012, 31(7):1305–1310.
15. Chen-Yuan Chiang1,2,3, Jen-Jyh Lee4, Shun-Tien Chien5 Glycemic Control and Radiographic Manifestations of Tuberculosis in Diabetic Patients International Union Against Tuberculosis and Lung Disease
16. Payam Tabarsi1, Parvaneh Baghaei1*, Majid Marjani1, William M Vollmer2, Mohammad- Reza Masjedi3 and Anthony D Harries4,5Changes in glycosylated haemoglobin and treatment outcomes in patients with tuberculosis in Iran ,Journal of diabetes and medical care.
17. Dr Meena Verma, Dr Sangeetha Paneri etal Effect of increasing duration of Diabetes Mellitus Type2 on Glycated Hemoglobin and Insulin sensitivity: Indian j. Clinical Biochemistry, 2006, 21 (1) 142-146.
18. Morsy AM, Zaher HH, Hassan MH, Shouman A: Predictors of treatment failure among tuberculosis patients under DOTS strategy in Egypt. East Mediterr Health J 2003, 9(4):689–701.
19. Alisjahbana B, Sahiratmadja E, Nelwan EJ, Purwa AM, Ahmad Y, Ottenhoff TH, Nelwan RH, Parwati I, van der Meer JW, Van Crevel R: The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin Infect Dis 2007, 45(4):428–4.
20. Bacakoglu F, Basoglu OK, Cok G, Sayiner A, Ates M: Pulmonary tuberculosis in patients with diabetes mellitus. Respiration 2001, 68(6):595–600.
21. Anand K. Patel, Kiran C. Rami , Feroz D. Ghanchi : Radiological presentation of patients of pulmonary tuberculosis with diabetes mellitus .Lung India Vol 28 ,Issue 1, Jan - Mar 2011.
22. Bashar M, Alcabes P, Rom WN, Condos R. Increased incidence of multidrug-resistant tuberculosis in diabetic patients on the Bellevue Chest Service, 1987 to 1997. Chest 2001; 120 (5): 1514- 9.
23. Morris JT, Seaworth BJ, McAllister CK. Pulmonary tuberculosis in diabetics. Chest 1992.
24. Sindhuri Avuthu, Vinay Mahishale, Bhagyashri Patil, Ajith Eti :Glycemic Control and Radiographic Manifestations of Pulmonary Tuberculosis in Patients with Type 2 Diabetes Mellitus. Sub-Saharan African Journal of Medicine /Vol 2/Issue 1/Jan-Mar 2015.
25. Yamashiro S, Kawakami K, Uezu K, Kinjo T, Miyagi K, et al. (2005) Lower expression of Th1-related cytokines and inducible nitric oxide synthase in mice with streptozotocin-induced diabetes mellitus infected with Mycobacterium tuberculosis. Clin Exp Immunol. 39: 57–64.

Dr Bhanu Rekha Bokam, M D

Professor, Department of Pulmonary Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences &Research Foundation, Chinoutpalli, Vijayawada, Krishna Dt., Andhra Pradesh, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.