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

Summary 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...

Full description

Saved in:
Bibliographic Details
Published in:The lancet. Diabetes & endocrinology 2014-09, Vol.2 (9), p.740-753
Main Authors: Riza, Anca Lelia, MD, Pearson, Fiona, PhD, Ugarte-Gil, Cesar, MD, Alisjahbana, Bachti, PhD, van de Vijver, Steven, MD, Panduru, Nicolae M, PhD, Hill, Philip C, MD, Ruslami, Rovina, PhD, Moore, David, PhD, Aarnoutse, Rob, PhD, Critchley, Julia A, DPhil, van Crevel, Reinout, Dr
Format: Article
Language:English
Subjects:
AIDS-Related Opportunistic Infections - drug therapy
AIDS-Related Opportunistic Infections - epidemiology
AIDS-Related Opportunistic Infections - immunology
Antitubercular Agents - administration & dosage
Blood Glucose
Chemoprevention - methods
Diabetes Mellitus, Type 2 - drug therapy
Diabetes Mellitus, Type 2 - epidemiology
Diabetes Mellitus, Type 2 - immunology
Drug Interactions
Endocrinology & Metabolism
Global Health
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - immunology
HIV-1 - isolation & purification
Humans
Immunocompromised Host
Other
Prognosis
Tuberculosis, Pulmonary - drug therapy
Tuberculosis, Pulmonary - epidemiology
Tuberculosis, Pulmonary - immunology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Summary 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.
ISSN:2213-8587
2213-8595
DOI:10.1016/S2213-8587(14)70110-X