Glycemic Control: A Strategic Approach for Successful Tuberculosis Treatment in Patients with Comorbid Diabetes Mellitus
https://doi.org/10.58838/2075-1230-2026-104-3-48-55
Abstract
The objective: to identify factors contributing to dysglycemia in patients with pulmonary tuberculosis and comorbid diabetes mellitus, and to assess the effectiveness of dysglycemia management based on the 24-hour glycemic variability.
Materials and methods. The study included 51 HIV-negative patients with advanced tuberculosis (TB) and decompensated type 1 or type 2 diabetes.
Results. Infection-induced dysglycemia driven by active TB was found to be the leading cause of glycemic decompensation in 98.0% of patients; this condition was frequently compounded by dietary non-compliance, poor self-monitoring, and drug-drug interactions. The introduction of the 24-hour glycemic variability as an additional clinical parameter enabled careful monitoring of glucose-lowering therapy resulting in glycemic profile stabilization within 3–8 weeks. Against this background, combined with the optimization of TB therapy, this approach yielded favorable TB treatment outcomes demonstrated by the radiographic improvements in 66.7% of patients, with the median time to sputum conversion of 2.2 months. Joint management by phthisiologists and endocrinologists combined with management of dysglycemia represents a strategic approach to enhancing TB treatment efficacy in this patient population.
About the Authors
V. V. Tinkova
National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Ministry of Health of the Russian Federation; N.I. Pirogov Russian National Research Medical University, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Valentina V. Tinkova, Candidate of Medical Sciences, Deputy Chief Physician for Medical Affairs, Assistant Professor, Department of Phthisiology
127473, Moscow, 4 Dostoevsky Street, Building 2;
Tel.: +7 (495) 631-15-15
O. V. Lovacheva
National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Olga V. Lovacheva, Doctor of Medical Sciences, Professor, Chief Researcher, Department of Differential Diagnosis and Treatment of Tuberculosis and Co-infections
127473, Moscow, 4 Dostoevsky Street, Building 2;
Tel.: +7 (495) 631-15-15
D. O. Churkin
National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Denis O. Churkin, TB specialist, Department of Respiratory Tuberculosis
127473, Moscow, 4 Dostoevsky Street, Building 2;
Tel.: +7 (495) 631-15-15
A. K. Karaeva
National Medical Research Center of Phthisiopulmonology and Infectious Diseases, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Alina K. Karaeva, Endocrinologist
127473, Moscow, 4 Dostoevsky Street, Building 2;
Tel.: +7 (495) 631-15-15
References
1. Dedov I., Shestakova M., Mayorova A. (editors). Standards of Specialized Diabetes Care / Edited by Dedov I.I., Shestakova M.V., Mayorov A.Yu. 11th Edition. Diabetes mellitus. 2023;26(2S):1-157. (In Russ.). https://doi.org/10.14341/DM13042
2. Ivanova DA, Belilovskiy EM, Bogorodskaya EM, Reshetnikov MN, Plotkin DV, Avdentova VB. The influence of comorbidities on treatment outcomes in patients with tuberculosis. Terapevticheskii Arkhiv (Ter. Arkh.). 2024;96(8):790–796 (In Russ.).
3. Komissarova O.G., Abdullaev R. Yu., Aleshina S.V., Romanov V.V. Pulmonary tuberculosis with multiple drug-resistant Mycobacterium tuberculosis in patients with diabetes mellitus. Consilium Medicum. 2018; 20 (4): 29–32. (In Russ.). https://doi.org/10.26442/2075-1753_2018.4.29-32
4. Sychyov DA, Ostroumova OD, editors. Drug-induced diseases. Moscow: Prometey; 2022. (In Russ.).
5. Baker M.A., Harries A.D., Jeon C.Y., et al. The impact of diabetes on tuberculosis treatment outcomes: a systematic review // BMC Med. – 2011. – № 9. – Р. 81. https://doi.org/10.1186/1741-7015-9-81
6. Bhattacharya P., Talukdar K., Barman B., et al. Clinical Spectrum and Medical Comorbidities in Tuberculosis: A Hospital-Based Study inNortheast India // Cureus. – 2020. – Vol. 12, № 9. – Р. e10580. https://doi.org/10.7759/cureus.10580
7. Cáceres G., Calderon R., Ugarte-Gil C. Tuberculosis and comorbidities: treatment challenges in patients with comorbid diabetes mellitus and depression // Therapeutic Advances in Infectious Disease. – 2022. – № 9. – Р. 20499361221095831.
8. Hajjar E.R., Cafiero A.C., Hanlon J.T. Polypharmacy in elderly patients // Am J Geriatr Pharmacother. – 2007. – Vol. 5, № 4. – Р. 345-351.
9. Khattak M., Rehman A.U., Muqaddas T., et al. Tuberculosis (TB) treatment challenges in TB-diabetes comorbid patients: a systematic review and meta-analysis // Ann Med. – 2024. – Vol. 56, № 1. – Р. 2313683.
10. Lin Y., Harries A.D., Kumar A.M.V, et al. Management of diabetes mellitus-tuberculosis: a guide to the essential practice. Paris, France: International Union Against Tuberculosis and Lung Disease, 2019. Available at: https://theunion.org/sites/default/files/2020-11/TheUnion_DMTB_Guide.pdf. Accessed September 27, 2025].
11. Niazi A.K., Kalra S. Diabetes and tuberculosis: a review of the role of optimal glycemic control // J Diabetes Metab Disord. – 2012. – Vol. 11, № 1. – Р. 28. https://doi.org/10.1186/2251-6581-11-28
12. Nyirenda J.L., Mbemba E., Chirwa M, et al. Acceptability and feasibility of tuberculosis and diabetes mellitus bidirectional screening and joint treatment services in Malawi: a cross-sectional study and a policy document review // BMJ Open. – 2023. – № 13. – Р. e062009. https://doi.org/10.1136/bmjopen-2022-062009
13. Rehman A.U., Khattak M., Mushtaq U., et al. The impact of diabetes mellitus on the emergence of multi-drug resistant tuberculosis and treatment failure in TB-diabetes comorbid patients: a systematic review and meta-analysis // Front Public Health. – 2023. – № 11. – Р. 1244450. https://doi.org/10.3389/fpubh.2023.1244450
14. Saifullah N., Abbas U., Masood K.I., Khan A., et al. Tuberculosis and diabetes mellitus: Relating immune impact of co-morbidity with challenges in disease management in high burden countries // Journal of Clinical Tuberculosis and Other Mycobacterial Diseases. – 2022. – № 29. – Р. 100343.
15. Van Crevel R., Critchley J.A. The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice // Trop. Med. Infect. Dis. – 2021. – № 6. – Р. 8. https://doi.org/10.3390/tropicalmed6010008
16. Viswanathan P., Iarikov D., Wassel R., Davidson A., Nambiar S. Hypoglycemia in patients treated with linezolid // Clin Infect Dis. – 2014. – Vol. 59, № 8. – Р. e93-5. https://doi.org/10.1093/cid/ciu487
17. Walker K., Toshner R., Sandeep Th.C., et al. Linezolid-induced hypoglycaemia in a patient with type 1 diabetes // The BrIitish Journal of diabetes and vascular disease. – 2012. – Vol. 12, № 4. – Р. 186-188. doi: 10.1177/1474651412458530
18. Zhao L., Gao F., Zheng C., Sun X. The Impact of Optimal Glycemic Control on Tuberculosis Treatment Outcomes in Patients With Diabetes Mellitus: Systematic Review and Meta-Analysis // JMIR Public Health Surveill. – 2024. – № 10. – Р. e53948. https://doi.org/10.2196/53948
19. Zhu Y., Forsman L.D., Chen C., Zhang H., et al. Drug Exposure and Treatment Outcomes in Patients With Multidrug-Resistant Tuberculosis and Diabetes Mellitus: A Multicenter Prospective Cohort Study From China // Clin Infect Dis. – 2024. – Vol. 79, № 2. – Р. 524-533. https://doi.org/10.1093/cid/ciae329
Review
For citations:
Tinkova V.V., Lovacheva O.V., Churkin D.O., Karaeva A.K. Glycemic Control: A Strategic Approach for Successful Tuberculosis Treatment in Patients with Comorbid Diabetes Mellitus. Tuberculosis and Lung Diseases. 2026;104(3):48-55. (In Russ.) https://doi.org/10.58838/2075-1230-2026-104-3-48-55
Views:
73
JATS XML
Email this article 