Background: The burden of tuberculosis and diabetes mellitus is significantly high in India. People with diabetes are at higher risk of developing active tuberculosis. The main purpose of this study is to determine prevalence of diabetes and pre-diabetes among TB cases. As the risks of treatment failure, death and reactivation are high in TB-DM patients, we had also included study of clinical profile of these patients.

Material and Method: We have done a prospective study over a period of two years. Study size was 1000 TB patients diagnosed at our institute. All willing patients above the age of 12 years were included in our study. We followed WHO criteria with Fasting glucose level (FGL) for diagnosis of diabetes and pre-diabetes. Tuberculosis patients with FGL more than /equal to 110 mg/dl were evaluated in details to study their clinical profile. Outcomes of these patients were noted from TB registers/records.

Result: Out of 1000 TB patients, 212 patients had impaired FGL. Among them, 80 TB patients had diabetes and 132 TB patients had pre diabetes. 15% among the 212 patient were previously diagnosed cases of diabetes mellitus on treatment. Impaired FGL was significantly associated with age group 31 to 45 years, male predominance, low socio economical status. Pulmonary tuberculosis and sputum positivity was common. Pleural TB was the most common type of extra-pulmonary tuberculosis seen. Out of 212, only 7 patients died before completion of DOTS under RNTCP.

Conclusion: In our study, the prevalence of diabetes is 8% and pre-diabetes is 13.2%. TB –DM patient pre-dominantly seen in age of group of 31-45 yrs TB-DM patient commonly had infective form of tuberculosis. Outcome of these patients on DOTS under RNTCP is significantly good. Screening patient with TB for FGL will definitely help in early detection of diabetes mellitus.

Keywords: Diabetes, Pre-diabetes, Tuberculosis, prevalence.

1. Harrison’s Principles of Internal medicine, 18^th
2. S. K. Sharma and A. Mohan. Tuberculosis, 2^nd Edition. Jaypee Brothers Medical Publications (P) LTD, 2001.
3. WHO-Collaborative framework for care and control of tuberculosis and diabetes.

WHO/HTN/TB/2011.15

4. Vijay V. et al. Prevalence of diabetes and pre diabetes and associated risk factors among tuberculosis patients in India. PLoS ONE 2012; 7: e41367.
5. Association of diabetes and tuberculosis a major health challenge. J. Indian Med. Assoc. Vol. 110 (9) 2012: 646-48.
6. Harries A.D., Murray M. B. et al. Defining the research agenda to reduce joint burden of DM and TB. Trop. Med. Int. Health 2010; 15: 659-63.
7. Jeon C.Y. Murray M.B. et al. DM increases the risk of active TB, symptomatic review of 13 studies PLoS Med. 2008; 5: e152.
8. Sen T., Joshi S. R., Udwadia Z. F. Tuberculosis and DM Merging Epidemic. J. Assoc. Physicians of India 2009; 57: 399-404.
9. Screening of Tuberculosis patients for DM: Pilot Project, Module for RNTCP staff 2009 (TD, MOH and HW, New Delhi)
10. Balkrishna S., Vijayan S., Nair S. et al. High diabetes prevalence among tuberculosis cases in Kerala, India. PloS ONE 2012; e46502.
11. Li L, Lin Y, Mi F et al. Screening of patients with Tuberculosis for Diabetes Mellitus in China. TROP Med Int. Health 2012, 17: 1294-301.
12. Singla R, Khan N. et al. Influence of diabetes on manifestations and treatment outcome of TB patients. Int. J. Tuberculosis Lung Dis. 2006: 10: 74 -9.
13. TB India 2013: Annual status report, RNTCP. CTD, New Delhi.
14. Soundarajan Raghuraman, Kavita P., Vasudeven S., Govindrajan et al. Prevalence of DM among TB patients in Urban Puducherry. N. Am. J. Med Sci. Jan 2014: 6(1): 30-34.
15. Would Health Organisation 2011, Global tuberculosis control 2011, Geneva.
16. Jeon C.Y., Harries A D, Baker M A, Hart JE, Kapur A et al (2010). Bi-directional screening for tuberculosis and diabetes; a systematic review. TROP Med Int. Health 15; 1300-1314.
17. Stevenson CR, Critonley JA, Forouhi NG, Rogli CG, Williams  G. et al (2007). Diabetes and the risk of tuberculosis: a neglected threat to public health? chronic Illn 3 : 228-245.
18. C, Boudin TB, Roglic G et al (2011). Nutrition, diabetes and tuberculosis in the epidemiological transition. PloS ONE 6: e21161.
19. Alisjahbana B, Sahiratmadja E, Nelwan EJ, Purva AM, Ahmad Y, Ottenhoff TH et all. The effect of type 2 DM on the presentation and treatment response of pulmonary tuberculosis. Clin Infect. Dis. 2007: 45: 428-35.
20. Collaborative framework for care and control of tuberculosis and diabetes: Report by WHO and IUATLD. Geneva: WHO (Accessed Sept 15, 2013).
21. Definition and diagnosis of diabetes mellitus and Intermediate hyperglycaemia: Report of a WHO/IDF consultation. Geneva: WHO (Accessed July 20, 2013).
22. National Programme for prevention and control of diabetes, CVD, and stroke: A manual for M.O. Govt of India –WHO collaborative programme (Accessed July 10, 2013).
23. Anjana R.M., Pradeepa R, Deepa M, Dutta M et al (2011). Prevalence of diabetes and pre-diabetes in urban and rural India: Phase I results of I (ICMR –India13) study. Diabetologia 54: 3022-3027.
24. Meena R, Jain N, Sharma M, Aurangabadwala R, Jain N (2011), Factors responsible for relapse under RNTCP. 21st Annual Congress of the European Resp. Society: Amsterdam. The Netherlands European Respir. J. (Supple. 55): 8055.
25. Zhang Q, Xiao H, Sugawala I (2009). Tuberculosis complicated by DM at Shanghai Hospital in China. Jpn J. Infect Dis. 62: 390-91.
26. Stevenson CR, Forouhi NG, Roglic G, William B. G., Lauer JA et al(2007). Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence. BMC Public Health 7: 234.
27. Rani B, Usha R, Thyagasvan K, Rajeshwari R (2007). Evaluation of an intermittent six month regimen in new PTB patients with DM. Indian J. Tuberculosis, 54: 168-176.

Dr Anita Saibannavar

Associate Professor and Head, Department of Pulmonary Medicine,

R.C.S.M.G.M.C., Kolhapur