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    VENKY

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    vimal raj
    Of the top 10 countries with the highest DM patient populations worldwide, 6 are also considered high TB burden countries by the WHO. Screening all adult TB patients for DM is recommended, but targeted screening of those over 40 years old, overweight/obese, family history of DM, excessive alcohol use, or history of gestational DM/pre-DM may be more cost-effective with limited resources. DM patients should receive similar TB treatment as non-DM patients but with more monitoring due to higher risk of treatment failure and recurrence.

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    VENKY

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    vimal raj
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    Of the top 10 countries with the highest DM patient populations worldwide, 6 are also considered high TB burden countries by the WHO. Screening all adult TB patients for DM is recommended, but targeted screening of those over 40 years old, overweight/obese, family history of DM, excessive alcohol use, or history of gestational DM/pre-DM may be more cost-effective with limited resources. DM patients should receive similar TB treatment as non-DM patients but with more monitoring due to higher risk of treatment failure and recurrence.

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    Of the top 10 countries with the highest DM patient populations worldwide, 6 are also considered high TB burden countries by the WHO. Screening all adult TB patients for DM is recommended, but targeted screening of those over 40 years old, overweight/obese, family history of DM, excessive alcohol use, or history of gestational DM/pre-DM may be more cost-effective with limited resources. DM patients should receive similar TB treatment as non-DM patients but with more monitoring due to higher risk of treatment failure and recurrence.

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    37 views20 pages

    VENKY

    Uploaded by

    vimal raj
    Of the top 10 countries with the highest DM patient populations worldwide, 6 are also considered high TB burden countries by the WHO. Screening all adult TB patients for DM is recommended, but targeted screening of those over 40 years old, overweight/obese, family history of DM, excessive alcohol use, or history of gestational DM/pre-DM may be more cost-effective with limited resources. DM patients should receive similar TB treatment as non-DM patients but with more monitoring due to higher risk of treatment failure and recurrence.

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     Of the ten countries with the highest number of DM patients worldwide, 6 are

    classified as “high burden” for TB by the World Health Organization, meaning


    they contribute to 80% of the TB cases worldwide
    Impact of DM on natural history of
    TB
    Should all TB patients be routinely screened for DM?

    • The WHO and the International Union Against Tuberculosis and Lung
    Disease recommend that all adult TB patients should be screened for
    DM.
    • If resources are tight, it may be more cost-effective to undertake
    targeted screening.

    • Those aged 40 years and above (the age threshold may be reduced
    in some countries of South Asia as DM tends to present at earlier ages)
    • Those who are overweight or obese (with body mass index of 25
    and above; the body mass index cut-off could be lower in the South
    Asian population)
    • Those with a family history of DM
    • Those who are known to consume excessive amounts of alcohol
    • Those with previous gestational DM or previous pre-DM
    Diagnosing DM in TB pts..
    DM treatment in TB..
    How TB drugs are affected by DM
    special considerations in managing
    DM patients with drug-susceptible
    TB
    TAKE HOME MESSAGE..
    • All adult TB patients should be offered screening for DM. If resources
    are limited, a targeted screening approach should be used (for example,
    screening TB patients more than 40 years of age).
    • Fasting blood glucose and, if resources are available, HbA1c are the
    preferred diagnostic tests for DM in patients with TB.
    • DM patients should be offered systematic screening for TB in high-TB
    burden countries where TB prevalence is greater than 100 per 100,000
    people.
    • In persons newly diagnosed with DM, systematic TB screening should be
    performed actively (i.e., it should be provider-initiated) using a TB symptom
    screen followed by Xpert MTB/RIF if there are suggestive TB symptoms.
    If resources are available, consideration can also be given to screening
    with a chest radiograph, and if there are any abnormalities on chest
    radiography further investigation can be carried out by Xpert MTB/RIF.
    • Treatment for drug-susceptible and drug-resistant TB is similar in
    persons with and without DM. Health workers should be vigilant about
    monitoring treatment response as treatment failure and recurrent TB are
    more common in persons with DM.
    • People with both DM and infectious TB should be treated for at least
    the first two weeks and preferably the first two months just in the TB clinic
    and visits to the DM clinic should be avoided wherever possible to prevent
    the transmission to health workers and persons with DM in that setting.
    • Metformin is the first-line drug of choice for treating persons with DM if
    medication is needed to control elevated glucose levels. Insulin may have to
    be considered if blood glucose levels are very high or in those whose blood
    glucose levels are not controlled with oral hypoglycaemic drugs.
    • People with DM and a history of previous cardiovascular disease should
    be offered low dose aspirin and a statin.
    • Patients with DM and TB need to be counselled about appropriate
    lifestyle management (smoking cessation, good diet and physical activity).
    • THANK U

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