• People attending TB clinics should be screened for diabetes and those attending diabetes clinics should be screened for TB if presenting with symptoms.
• Diabetes may be associated with delayed sputum conversion (>60 days), higher probability of tuberculosis treatment failure, higher recurrence and relapse rates, higher overall mortality, higher rates of multi-drug resistance TB and more atypical presentation in hyperosmolar hyperglycemic nonketotic coma or ketoacidosis
• For both conditions, controlling blood sugar, being more physically active, avoiding chronic stress, getting enough sleep and maintaining ideal weight are recommended.

Review Drug Requirements

• Rifampicin is a potent hepatic enzyme-inducing agent, accelerates the metabolism of oral hypoglycemic agents and shortens the plasma half-life of sulphonylureas
• Isoniazid antagonizes sulphonylureas, impairs insulin release and action and leads to increased requirement of insulin and oral antidiabetic medication
• Therefore people with diabetes may require an increase in dosage of antidiabetic medication if they develop tuberculosis

Use Oral Antidiabetic Medicines Carefully in Tuberculosis

• People with diabetes mellitus and tuberculosis should be treated with insulin injection, or in case a diabetic with tuberculosis is on oral hypoglycemic agents, it may be necessary to switch to insulin.
• Tuberculosis affects both the liver and pancreas: oral antidiabetic drugs are contraindicated in hepatic disease, which is a common adverse effect of antituberculous therapy.
• Metformin produces weight loss, particularly in high doses, and it is also an anorectic.
• Marked weight loss and higher insulin and caloric needs in tuberculosis are other important indications for reviewing oral antidiabetic therapy in diabetes mellitus.