title: Clinical management of concurrent diabetes and tuberculosis and the implications for patient services.
abstract: Diabetes triples the risk for active tuberculosis, thus the increasing burden of type 2 diabetes will help to sustain the present tuberculosis epidemic. Recommendations have been made for bidirectional screening, but evidence is scarce about the performance of specific tuberculosis tests in individuals with diabetes, specific diabetes tests in patients with tuberculosis, and screening and preventive therapy for latent tuberculosis infections in individuals with diabetes. Clinical management of patients with both diseases can be difficult. Tuberculosis patients with diabetes have a lower concentration of tuberculosis drugs and a higher risk of drug toxicity than tuberculosis patients without diabetes. Good glycaemic control, which reduces long-term diabetes complications and could also improve tuberculosis treatment outcomes, is hampered by chronic inflammation, drug-drug interactions, suboptimum adherence to drug treatments, and other factors. Besides drug treatments for tuberculosis and diabetes, other interventions, such as education, intensive monitoring, and lifestyle interventions, might be needed, especially for patients with newly diagnosed diabetes or those who need insulin. From a health systems point of view, delivery of optimum care and integration of services for tuberculosis and diabetes is a huge challenge in many countries. Experience from the combined tuberculosis and HIV/AIDS epidemic could serve as an example, but more studies are needed that include economic assessments of recommended screening and systems to manage concurrent tuberculosis and diabetes.
authors.affiliation: Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands; Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
authors.forename: Anca Lelia
authors.initials: AL
authors.lastname: Riza
authors.affiliation: Population Health Research Institute, St Georges University, London, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Pearson
authors.affiliation: Universidad Peruana Cayetano Heredia, Lima, Peru; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Cesar
authors.initials: C
authors.lastname: Ugarte-Gil
authors.affiliation: Center for TB-HIV research, Medical Faculty, Padjadjaran University, Hasan Sadikin Hosptial, Bandung, Indonesia.
authors.forename: Bachti
authors.initials: B
authors.lastname: Alisjahbana
authors.affiliation: African Population and Health Research Center, Nairobi, Kenya; Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, Netherlands.
authors.forename: Steven
authors.initials: S
authors.lastname: van de Vijver
authors.affiliation: Human Genomics Laboratory, University of Medicine and Pharmacy of Craiova, Craiova, Romania; 2nd Clinical Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Nicolae M
authors.initials: NM
authors.lastname: Panduru
authors.affiliation: Centre for International Health, Faculty of Medicine, Otago University, Dunedin, New Zealand.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Hill
authors.affiliation: Department of Pharmacology and Therapy, Faculty of Medicine, Padjadjaran University, Bandung, Indonesia.
authors.forename: Rovina
authors.initials: R
authors.lastname: Ruslami
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Moore
authors.affiliation: Department of Pharmacy, Radboud University Medical Center, Nijmegen, Netherlands.
authors.forename: Rob
authors.initials: R
authors.lastname: Aarnoutse
authors.affiliation: Population Health Research Institute, St Georges University, London, UK.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Critchley
authors.affiliation: Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands. Electronic address: reinout.vancrevel@radboudumc.nl.
authors.forename: Reinout
authors.initials: R
authors.lastname: van Crevel
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D000995:Antitubercular Agents / Q000008:administration & dosage*; D001786:Blood Glucose; D018890:Chemoprevention / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D004347:Drug Interactions; D014943:Global Health; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology; D015497:HIV-1 / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D011379:Prognosis; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy* / Q000453:epidemiology / Q000276:immunology
chemical_list: D000995:Antitubercular Agents; D001786:Blood Glucose