Editor–We read with great interest the article by Bailey and colleagues (Clin Med August 2011 pp 344–7). Treatment of people with tuberculosis (TB) and diabetes is indeed complicated. Not only does rifampicin potentially adversely alter the pharmacokinetics of gliclazide,1 glipizide,2 pioglitazone,3 nateglinide4 and repaglinide,5 but like isoniazid, it may increase insulin requirements.6 Liver and nerve toxicity from anti-TB drugs may be difficult to distinguish from diabetes-associated non-alcoholic fatty liver disease and peripheral neuropathy respectively and for those with co-morbid HIV infection with access to treatment, there is the added complication of antiretroviral-associated insulin resistance.7 TB itself may precipitate hyperglycaemia by a stress hormone response and there is some evidence of glucose intolerance in TB patients reverting to normal in up to 75% of patients after three months of TB treatment.8
We wholeheartedly endorse Bailey and Grant's conclusion that TB and diabetes demand increased attention from clinicians and academics if we are to ensure that future patients receive optimal management of both conditions.
References
- 1.Park JY, Kim KA, Park PW, Park CW, Shin JG. Effect of rifampin on the pharmacokinetics and pharmacodynamics of gliclazide Clin Pharmacol Ther 2003. 74 334–40 [DOI] [PubMed] [Google Scholar]
- 2.Niemi M, Backman JT, Neuvonen M, Neuvonen PJ, Kivisto KT. Effects of rifampin on the pharmacokinetics and pharmacodynamics of glyburide and glipizide Clin Pharmacol Ther 2001. 69 400–6 10.1067/mcp.2001.115822 [DOI] [PubMed] [Google Scholar]
- 3.Jaakkola T, Backman JT, Neuvonen M, Laitila J, Neuvonen PJ. Effect of rifampicin on the pharmacokinetics of pioglitazone Br J Clin Pharmacol 2006. 61 70–8 10.1111/j.1365-2125.2005.02515.x [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Niemi M, Backman JT, Neuvonen M, Neuvonen PJ. Effect of rifampicin on the pharmacokinetics and pharmacodynamics of nateglinide in healthy subjects Br J Clin Pharmacol 2003. 56 427–32 10.1046/j.1365-2125.2003.01884.x [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Hatorp V, Hansen KT, Thomsen MS. Influence of drugs interacting with CYP3A4 on the pharmacokinetics, pharmacodynamics, and safety of the prandial glucose regulator repaglinide J Clin Pharmacol 2003. 43 649–60 [PubMed] [Google Scholar]
- 6.Atkin SL, Masson EA, Bodmer CW, Walker BA, White MC. Increased insulin requirement in a patient with type 1 diabetes on rifampicin. Diabet Med. 1993;10:392. doi: 10.1111/j.1464-5491.1993.tb00086.x. [DOI] [PubMed] [Google Scholar]
- 7.Tebas P. Insulin resistance and diabetes mellitus associated with antiretroviral use in HIV-infected patients: pathogenesis, prevention, and treatment options J Acquir Immune Defic Syndr 2008. 49Suppl 2 S86–92 10.1097/QAI.0b013e31818651e6 [DOI] [PubMed] [Google Scholar]
- 8.Oluboyo PO, Erasmus RT. The significance of glucose intolerance in pulmonary tuberculosis Tubercle 1990. 71 135–8 10.1016/0041-3879(90)90010-6 [DOI] [PubMed] [Google Scholar]