Volume 80, Issue 4
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645


Diabetes mellitus (DM) is an emerging chronic health condition of developed and developing countries. We conducted a retrospective cohort study of patients with active, culture-confirmed tuberculosis (TB) in Maryland to determine the impact of DM on TB treatment outcomes. Of 297 TB patients, 42 (14%) had DM. Patients with diabetes had 2.0 times higher odds of death than patients without diabetes (95% confidence interval [CI] 0.74–5.2, = 0.18). Adjusting for human immunodeficiency virus (HIV), age, weight, and foreign birth, the odds of death were 6.5 times higher in patients with diabetes than patients without diabetes (95% CI 1.1–38.0, = 0.039). In pulmonary TB patients, time to sputum culture conversion was longer in patients with diabetes than patients without diabetes (median 49 versus 39 days, = 0.09). Two-month culture conversion proportions were similar (70% and 69%). Treatment failure occurred in 4.1% of patients without diabetes and 6.7% of patients with diabetes ( = 0.51). In conclusion, DM was a risk factor for death in Maryland TB patients. There was a trend toward increased time to culture conversion; two-month culture conversion proportions, however, were similar.


Article metrics loading...

The graphs shown below represent data from March 2017
Loading full text...

Full text loading...



  1. World Health Organization, 2008. Global Tuberculosis Control: Surveillance, Planning, Financing. Geneva: WHO.
  2. Wild S, Roglic G, Green A, Sicree R, King H, 2004. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27 : 1047–1053. [Google Scholar]
  3. National Diabetes Statistics, 2007. Available at: http://diabetes.niddk.nih.gov/dm/pubs/statistics/. Accessed February 4, 2009.
  4. King H, Aubert RE, Herman WH, 1998. Global burden of diabetes, 1995–2025: prevalence, numerical estimates, and projections. Diabetes Care 21 : 1414–1431. [Google Scholar]
  5. Wang JY, Lee LN, Hsueh PR, 2005. Factors changing the manifestation of pulmonary tuberculosis. Int J Tuberc Lung Dis 9 : 777–783. [Google Scholar]
  6. Stevenson CR, Forouhi NG, Roglic G, Williams BG, Lauer JA, Dye C, Unwin N, 2007. Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence. BMC Public Health 7 : 234. [Google Scholar]
  7. Coker R, McKee M, Atun R, Dimitrova B, Dodonova E, Kuznetsov S, Drobniewski F, 2006. Risk factors for pulmonary tuberculosis in Russia: case-control study. BMJ 332 : 85–87. [Google Scholar]
  8. Mboussa J, Monabeka H, Kombo M, Yokolo D, Yoka-Mbio A, Yala F, 2003. Course of pulmonary tuberculosis in diabetics. Rev Pneumol Clin 59 : 39–44. [Google Scholar]
  9. Shetty N, Shemko M, Vaz M, D’Souza G, 2006. An epidemiological evaluation of risk factors for tuberculosis in South India: a matched case control study. Int J Tuberc Lung Dis 10 : 80–86. [Google Scholar]
  10. Jabbar A, Hussain SF, Khan AA, 2006. Clinical characteristics of pulmonary tuberculosis in adult Pakistani patients with coexisting diabetes mellitus. East Mediterr Health J 12 : 522–527. [Google Scholar]
  11. Kim SJ, Hong YP, Lew WJ, Yang SC, Lee EG, 1995. Incidence of pulmonary tuberculosis among diabetics. Tuber Lung Dis 76 : 529–533. [Google Scholar]
  12. Jick SS, Lieberman ES, Rahman MU, Choi HK, 2006. Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis Rheum 55 : 19–26. [Google Scholar]
  13. Dyck RF, Klomp H, Marciniuk DD, Tan L, Stang MR, Ward HA, Hoeppner VH, 2007. The relationship between diabetes and tuberculosis in Saskatchewan: comparison of registered Indians and other Saskatchewan people. Can J Public Health 98 : 55–59. [Google Scholar]
  14. Leung CC, Lam TH, Chan WM, Yew WW, Ho KS, Leung GM, Law WS, Tam CM, Chan CK, Chang KC, 2008. Diabetic control and risk of tuberculosis: a cohort study. Am J Epidemiol. 167 : 1486–1494. [Google Scholar]
  15. Jeon CY, Murray MB, 2008. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med 5 : e152. [Google Scholar]
  16. Morsy AM, Zaher HH, Hassan MH, Shouman A, 2003. Predictors of treatment failure among tuberculosis patients under DOTS strategy in Egypt. East Mediterr Health J 9 : 689–701. [Google Scholar]
  17. Alisjahbana B, Sahiratmadja E, Nelwan EJ, Purwa AM, Ahmad Y, Ottenhoff TH, Nelwan RH, Parwati I, van der Meer JW, van Crevel R, 2007. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin Infect Dis 45 : 428–435. [Google Scholar]
  18. Guler M, Unsal E, Dursun B, Aydln O, Capan N, 2007. Factors influencing sputum smear and culture conversion time among patients with new case pulmonary tuberculosis. Int J Clin Pract 61 : 231–235. [Google Scholar]
  19. Oursler KK, Moore RD, Bishai WR, Harrington SM, Pope DS, Chaisson RE, 2002. Survival of patients with pulmonary tuberculosis: clinical and molecular epidemiologic factors. Clin Infect Dis 34 : 752–759. [Google Scholar]
  20. Wang CS, Yang CJ, Chen HC, Chuang SH, Chong IW, Hwang JJ, Huang MS, 2009. Impact of type 2 diabetes on manifestations and treatment outcome of pulmonary tuberculosis. Epidemiol Infect 137 : 203–210. [Google Scholar]
  21. Blumberg HM, Burman WJ, Chaisson RE, Daley CL, Etkind SC, Friedman LN, Fujiwara P, Grzemska M, Hopewell PC, Iseman MD, Jasmer RM, Koppaka V, Menzies RI, O’Brien RJ, Reves RR, Reichman LB, Simone PM, Starke JR, Vernon AA, American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society, 2003. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis. Am J Respir Crit Care Med 167 : 603–662. [Google Scholar]
  22. Sterling TR, Zhao Z, Khan A, Chaisson RE, Schluger N, Mangura B, Weiner M, Vernon A, Tuberculosis Trials Consortium, 2006. Mortality in a large tuberculosis treatment trial: modifiable and non-modifiable risk factors. Int J Tuberc Lung Dis 10 : 542–549. [Google Scholar]
  23. Wang CS, Chen HC, Yang CJ, Wang WY, Chong IW, Hwang JJ, Huang MS, 2008. The impact of age on the demographic, clinical, radiographic characteristics and treatment outcomes of pulmonary tuberculosis patients in Taiwan. Infection 36 : 335–340. [Google Scholar]
  24. Olmos P, Donoso J, Rojas N, Landeros P, Schurmann R, Retamal G, Meza M, Martinez C, 1989. Tuberculosis and diabetes mellitus: a longitudinal-retrospective study in a teaching hospital. Rev Med Chil 117 : 979–983. [Google Scholar]
  25. Swai AB, McLarty DG, Mugusi F, 1990. Tuberculosis in diabetic patients in Tanzania. Trop Doct 20 : 147–150. [Google Scholar]
  26. Shah BR, Hux JE, 2003. Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care 26 : 510–513. [Google Scholar]
  27. Peleg AY, Weerarathna T, McCarthy JS, Davis TM, 2007. Common infections in diabetes: pathogenesis, management and relationship to glycaemic control. Diabetes Metab Res Rev 23 : 3–13. [Google Scholar]
  28. Restrepo BI, Fisher-Hoch SP, Smith B, Jeon S, Rahbar MH, McCormick JB, Nuevo Santander Tuberculosis Trackers, 2008. Mycobacterial clearance from sputum is delayed during the first phase of treatment in patients with diabetes. Am J Trop Med Hyg 79 : 541–544. [Google Scholar]
  29. Steinbach MM, Klein SJ, Deskowitz M, 1935. Experimental diabetes and tuberculosis in the dog. Am Rev Tuberc 32 : 665. [Google Scholar]
  30. Moutschen MP, Scheen AJ, Lefebvre PJ, 1992. Impaired immune responses in diabetes mellitus: analysis of the factors and mechanisms involved. Relevance to the increased susceptibility of diabetic patients to specific infections. Diabete Metab 18 : 187–201. [Google Scholar]
  31. Wang CH, Yu CT, Lin HC, Liu CY, Kuo HP, 1999. Hypodense alveolar macrophages in patients with diabetes mellitus and active pulmonary tuberculosis. Tuber Lung Dis 79 : 235–242. [Google Scholar]
  32. Yamashiro S, Kawakami K, Uezu K, Kinjo T, Miyagi K, Nakamura K, Saito A, 2005. Lower expression of Th1-related cytokines and inducible nitric oxide synthase in mice with streptozotocin-induced diabetes mellitus infected with Mycobacterium tuberculosis. Clin Exp Immunol 139 : 57–64. [Google Scholar]
  33. Martens GW, Arikan MC, Lee J, Ren F, Greiner D, Kornfeld H, 2007. Tuberculosis susceptibility of diabetic mice. Am J Respir Cell Mol Biol 37 : 518–524. [Google Scholar]
  34. Restrepo BI, Fisher-Hoch SP, Pino PA, Salinas A, Rahbar MH, Mora F, Cortes-Penfield N, McCormick JB, 2008. Tuberculosis in poorly controlled type 2 diabetes: altered cytokine expression in peripheral white blood cells. Clin Infect Dis 47 : 634–641. [Google Scholar]
  35. Niemi M, Backman JT, Neuvonen M, Neuvonen PJ, Kivisto KT, 2001. Effects of rifampin on the pharmacokinetics and pharmacodynamics of glyburide and glipizide. Clin Pharmacol Ther 69 : 400–406. [Google Scholar]
  36. Nijland HM, Ruslami R, Stalenhoef JE, Nelwan EJ, Alisjahbana B, Nelwan RH, van der Ven AJ, Danusantoso H, Aarnoutse RE, van Crevel R, 2006. Exposure to rifampicin is strongly reduced in patients with tuberculosis and type 2 diabetes. Clin Infect Dis 43 : 848–854. [Google Scholar]

Data & Media loading...

  • Received : 06 Nov 2008
  • Accepted : 09 Jan 2009

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error