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Review
. 2009 Dec;9(12):737-46.
doi: 10.1016/S1473-3099(09)70282-8.

Tuberculosis and diabetes mellitus: convergence of two epidemics

Kelly E Dooley  1 , Richard E Chaisson
Affiliations
Review

Tuberculosis and diabetes mellitus: convergence of two epidemics

Kelly E Dooley et al. Lancet Infect Dis. 2009 Dec.

Abstract

The link between diabetes mellitus and tuberculosis has been recognised for centuries. In recent decades, tuberculosis incidence has declined in high-income countries, but incidence remains high in countries that have high rates of infection with HIV, high prevalence of malnutrition and crowded living conditions, or poor tuberculosis control infrastructure. At the same time, diabetes mellitus prevalence is soaring globally, fuelled by obesity. There is growing evidence that diabetes mellitus is an important risk factor for tuberculosis and might affect disease presentation and treatment response. Furthermore, tuberculosis might induce glucose intolerance and worsen glycaemic control in people with diabetes. We review the epidemiology of the tuberculosis and diabetes epidemics, and provide a synopsis of the evidence for the role of diabetes mellitus in susceptibility to, clinical presentation of, and response to treatment for tuberculosis. In addition, we review potential mechanisms by which diabetes mellitus can cause tuberculosis, the effects of tuberculosis on diabetic control, and pharmacokinetic issues related to the co-management of diabetes and tuberculosis.

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Figures

Figure
Figure. Projected prevalent diabetes cases and current worldwide tuberculosis incidence
Estimated number and percent of individuals with diabetes mellitus in 2010 compared with 2030 projections are shown. Tuberculosis incidence per 100 000 population data for 2007 are shown. Data from International Diabetes Foundation and WHO.,
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