Review
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. May 15, 2024; 15(5): 853-866
Published online May 15, 2024. doi: 10.4239/wjd.v15.i5.853
Tuberculosis-diabetes comorbidities: Mechanistic insights for clinical considerations and treatment challenges
Md Abdul Alim Al-Bari, Nicholas Peake, Nabil Eid
Md Abdul Alim Al-Bari, Department of Pharmacy, University of Rajshahi, Rajshahi 6205, Bangladesh
Nicholas Peake, Biosciences and Chemistry and Biomolecular Research Centre, Sheffield Hallam University, Sheffield S1 1WB, United Kingdom
Nabil Eid, Department of Anatomy, Division of Human Biology, School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia
Author contributions: Al-Bari MAA conceptualization, validation, writing-original draft, review and editing the final drafts; Eid N validation of original draft, review and editing the final drafts; Peake N edited the manuscript.
Conflict-of-interest statement: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Md Abdul Alim Al-Bari, PhD, Professor, Department of Pharmacy, University of Rajshahi, Dhaka-Rajshahi Highway, Rajshahi 6205, Bangladesh. alimalbari347@ru.ac.bd
Received: January 9, 2024
Peer-review started: January 9, 2024
First decision: January 27, 2024
Revised: February 8, 2024
Accepted: March 21, 2024
Article in press: March 21, 2024
Published online: May 15, 2024
Processing time: 122 Days and 2.6 Hours
Abstract

Tuberculosis (TB) remains a leading cause of death among infectious diseases, particularly in poor countries. Viral infections, multidrug-resistant and ex-tensively drug-resistant TB strains, as well as the coexistence of chronic illnesses such as diabetes mellitus (DM) greatly aggravate TB morbidity and mortality. DM [particularly type 2 DM (T2DM)] and TB have converged making their control even more challenging. Two contemporary global epidemics, TB-DM behaves like a syndemic, a synergistic confluence of two highly prevalent diseases. T2DM is a risk factor for developing more severe forms of multi-drug resistant-TB and TB recurrence after preventive treatment. Since a bidirectional relationship exists between TB and DM, it is necessary to concurrently treat both, and promote recommendations for the joint management of both diseases. There are also some drug-drug interactions resulting in adverse treatment outcomes in TB-DM patients including treatment failure, and reinfection. In addition, autophagy may play a role in these comorbidities. Therefore, the TB-DM comorbidities present several health challenges, requiring a focus on multidisciplinary collaboration and integrated strategies, to effectively deal with this double burden. To effectively manage the comorbidity, further screening in affected countries, more suitable drugs, and better treatment strategies are required.

Keywords: Diabetes mellitus; Tuberculosis; Coinfections; Comorbidity; Drug-drug interactions; Autophagy; Treatment challenges

Core Tip: Tuberculosis (TB)-diabetes mellitus (DM) comorbidities are major health problems due to the increasing number of type 2 DM (T2DM) cases in developing countries, where active TB is prevalent. This can negatively affect the outcomes of TB-DM treatments. T2DM is commonly related to obesity and is being increasingly recognized as a risk factor for TB, whereas TB may worsen glycemic control among DM patients. These bidirectional relationships require more effective drugs, better treatment strategies, and the need to adjust dose schedules for controlling hyperglycemia during active TB infection.