Table I.

Clinical recommendations on patients with tuberculosis and diabetes

Diabetic patients should be routinely screened for TB symptoms such as persistent cough (> 2 weeks), night sweats, weight loss and fever as part of regular clinical check-ups. Patients with a positive symptom screen should be referred to TB service for further evaluation in accordance with the local guidelines. Diabetes mellitus may modify the clinical course of TB. Also, diabetic patients may have slightly different TB radiological presentation.

Patients with newly diagnosed TB should be screened for DM. It is advisable to screen with fasting blood glucose and/or HbA1c at the time of TB diagnosis, and repeat it after 3 months of TB treatment. The best screening test is still not known.

Diabetes treatment has to be optimized during TB therapy in order to achieve good metabolic control. Insulin therapy is the most suitable regimen for TB patients with poor control on oral agents.

All diabetic patients with TB should be treated with the current standard four-drug treatment regimen of first-line drugs (isoniazid, rifampicin, pyrazinamide and ethambutol). It requires a minimum of 6 months in two phases: 2 months of all four drugs in the intensive phase and 4 months of isoniazid and rifampicin in the continuation stage.

It is recommended to pay special attention to outcomes of TB therapy in diabetic patients. Diabetes adversely affects the treatment in terms of negative smears, cultures and radiological improvement. Patients may need longer treatment in order to achieve success.

Diabetic patients after completion of TB treatment should attend a TB outpatient clinic in order to ensure follow-up and rapid detection of a possible relapse.