Unrelenting cough in diabetics? It could be TB

PUNE: Diabetic Ankit (name changed on request) thought he was infected with Covid-19 after his cough did not subside with routine medication. Various investigations, however, led to the detection of pulmonary tuberculosis (TB).
"People with a weak immune system are at a higher risk of progressing from latent to active TB. About 10% of TB cases globally are linked to diabetes," said Ruby Hall Clinic's chief physician and diabetologist Dr Sanjay Agarwal. In case of people with latent TB infection, their body is able to fight the bacteria to stop its growth.
The high prevalence of diabetes in low- and middle-income countries, where TB is endemic, is considered one of the major factors hindering the global TB target of a 90% reduction in its incidence by 2035. India aims to eliminate TB by 2025.
"People should [take tests to] rule out TB if they have symptoms like persisting fever, cough and weight-loss. This applies to people of all the sections of the society, especially those with diabetes," said Dr Agarwal, who is also national secretary of the Research Society for the Study of Diabetes in India (RSSDI).
The aim of RSSDI is to conduct and facilitate diabetes research in India. It has a direct bearing on clinical practice and the prevention and management of diabetes.
Experts have underlined that the risk of developing active TB is a two-step process, beginning with initial exposure to and infection by Mycobacterium tuberculosis, followed by subsequent progression to the disease.
"Fever and blood in cough are more common in the diabetic population compared to the general population," said Mumbai-based endocrinologist Dr David Chandy of Sir HN Reliance Foundation Hospital.
There is a two-to-four-fold higher risk of active TB in individuals with diabetes and up to 30% of individuals with TB are likely to have diabetes, he added.
Not just cases of TB-diabetes detections galore, stories of faster recovery are also plenty. A 16-year-old boy diagnosed with TB and diabetes bounced back to the normal routine within six months of treatment.
"The average of his three-month blood sugars were extremely high. After insulin and TB treatment for six months, he improved. On his last OPD visit this month, his TB had almost resolved. His weight was normal and sugars were well controlled," Dr Chandy said.
In Maharashtra, the public health department recently detected 9,780 patients with both diabetes and tuberculosis during the massive screening drive held between January 1 and September 30 last year, which screened over a lakh citizens.
"The detections are important as diabetes increases the risk of developing TB and can worsen outcomes. TB, in turn, can disturb sugar control in diabetics," Dr Agarwal said. Every year, World TB Day is observed on March 24. This year, the theme is 'Yes! We can end TB!'