Impact of Diabetes Mellitus on Spectrum of Presentation of Tuberculosis

Abstract

Introduction: Increased occurrence of tuberculosis in diabetic population is known since long time. Tuberculosis
(TB) remains one of the world’s deadliest communicable diseases and India currently bears the highest burden of
tuberculosis in the World. Diabetes mellitus (DM) is becoming the epidemic of the 21st century with India having
the second largest diabetic populationglobally. This emphasizes the importance of investigating the association of
tuberculosis and diabetes mellitus.
Aim: To evaluate clinic-radiological presentations of tuberculosis (pulmonary and extra pulmonary) in diabetic
patients compared to non-diabetic patients.
Materials and Methods: Patients with active tuberculosis with and without diabetes mellitus were enrolled and
the two groups were matched for age, sex, addiction habits, history of contact with tuberculosis and previous
treatment for tuberculosis. Spectrums of tubercular involvement in both the groups were studied including
severity of the disease. A symptom score comprising major TB related symptoms and a composite severity score
utilizing clinical, radiological, and microbiological parameters were used to compare TB severity between the two
groups.
Results: Patients with TB with DM were found to have male preponderance (70%), higher BMI, increased chance
of having isolated lower lobe lesion (8%), multilobar lesion (42%) and cavitary lesion (20%), significantly higher
TB symptom score and TB severity score compared to patients with TB without DM. The TB severity score has
significant correlation with level of HbA1c at presentation.
Conclusion: Presence of coexistent diabetes along with tuberculosis results in increased severity of tuberculosis
and its severity has direct correlation with poor glycemic status at presentation.