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ISSN No:-2456-2165
Abstract:- Association of diabetes with tuberculosis is History was obtained from each subjects regarding
well known. The converse relation (i.e.) patients with past history of tuberculosis, previous state of diabetes
tuberculosis have higher prevalence of impaired glucose mellites and family history of diabetes. A questionnaires was
tolerance was accepted later. In this study we tried to completed for each subject on which age, sex, duration of
determine the prevalence rate of impaired glucose illness, height without shoes and weight were measured and
tolerance in newly detected pulmonary tuberculosis body mass index calculated as (Kg/m2)
patients. In this study impaired glucose tolerance was
found in 22% (11patients), diabetes mellitus found in The following investigations were carried out
8% (4 patients). After two months of treatment for Mantoux test: Test was done in all patients by using
tuberculosis 5 patients of impaired glucose tolerance purified protein derivatives (PPD) supplied by the King
reverted to normal, 6 patients remained impaired Institute Guindy, Madras (stabilized 1 TU, PPD). The
glucose tolerant. In this study 70% (35) of patients had test was read on the third day and considered positive if
sputum positivity, out of 35 patients, 24 (48%) patients any induration exceeded 10 mm.
showed normal glucose tolerance, 11(22%) patients White Blood Cell count: WBC count was done with
showed impaired glucose tolerance. As per this study Neubaeur's chamber
there is no easy way to identify the tuberculosis patients ESR estimation: ESR estimated by standard
with asymptomatic diabetes. There is significant Westergren's method.
correlation between sputum positivity and impaired Haemoglobin: Haemoglobin estimated by Sahli's
glucose tolerance. (acid-haematin) method.
Blood Urea, Creatinine: Ureas, Creatinine were
I. INTRODUCTION estimated by Autoanalyser.
Sputum for AFB:
The aim of present study is to determine the
significance of association of impaired glucose tolerance in There samples of sputum were collected and
pulmonary tubercolsis. To determine the prevalence rate of examined as per RNTCP guidelines.
impaired glucose tolerance in tubercolsis patients by means X-ray: Plain x-ray chest was taken for each care with
of oral glucose tolerance test in newly detected pulmonary routine postero anterior rich and it was read by the
tubercolsis patients, attending the TB clinic of Government independent observers to avoid any bias. X-ray films
Coimbatore Medical College Hospital, Coimbatore. were read regard to the type of the diseases, side
involved (unilateral/Bilateral), zones of the lung
II. MATERIALS AND METHODS involved and the presence or absence of fibrocavitory
lesions. With regard to the type of the diseases, the cases
A total of 50 patients who were attending Tuberculosis were divided into five categories.
Clinic of Govt. Coimbatore Medical College Hospital who Bilateral lung involvement: In the form of infiltration or
were newly detected not on Anti tuberculosis treatment consolidation.
previously, included in this study. Most of them belonged to Extensive unilateral involvement
lower socioeconomic status, since the Government Cavitation with fibrosis
Coimbatore Medical College Hospital itself caters mainly Unilateral upper zone infiltration
the middle class and lower class. All the study patients were Unilateral lower zone infiltration
registered with detailed history and physical examination.
B. Glucose Tolerance Test
A. Exclusion Criteria The ability of the body to utilize carbohydrate may be
Known diabetic developed tuberculosis ascertained by measuring its carbohydrate intolerance. It is
Patients who are on steroids indicated by the nature of intolerance. It is indicated by the
Patients who are on drugs nature of blood glucose curve following the administration
Age below 20 years and above 60 years of glucose. Thus glucose tolerance is a valuable diagnostic
Pregnant women aid.
Very sick patients
Patients with moderate to massive haemoptysis
Patients having body mass index less than 20
The evidence that diabetic patients have an increased [1]. RNTCP guidelines issued by Central TB division,
risk of developing tuberculosis is irrefutable. The converse Ministry of Health and Family Welfare. Govt of India.
relation (i.e.) patients with tuberculosis have higher [2]. Subbash et al. Drug resistant tuberculosis in diabetes
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the detection of glucose intolerance, as in the study reported WHO, Geneva. Global burden of Diabetes 1995-2025.
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glucose intolerance is indeed greater in patients with Medical Association 2002 Mar; 100 (3): 144-8.
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5.6% to 39.1% but comparison between different studies is epidemic: implication for India. Indian Journal of
difficult due to differing criteria for the diagnosis of Medical Research 2002 Oct; 116: 121-132.
impaired glucose tolerance. Now, the present study is based [6]. Ramachandran et al. epidemiology of type 2 diabetes.
on the WHO criteria and recommended methodology for Indian J. med. Association. 100(7): 425-7.
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with tuberculosis. Oral Glucose Tolerance at the time of [8]. Tamura et al. A study on relation between active
diagnosis showed that 22 %( 11) had impaired glucose pulmonary tuberculosis and underlying diseases.
tolerance and 8%(4) had diabetes mellites. Repeat oral Kekkaku. Sep; 76(9): 619-24.
glucose tolerance test showed that 5 cases reverted to [9]. Basoglu et al. The oral glucose tolerance test in
normal, 6 cases (12%) remained impaired glucose tolerant. patients with respiratory infections. Monadi Arch
Statistical analysis by paired T test shows that no significant chest Dis. 1999 Aug; 54(4): 307-10.
correlation between initial and repeat oral glucose tolerance [10]. Jawad et al. Glucose intolerance in pulmonary
test. So the impaired glucose tolerance in initial screening is tuberculosis. J Pak Med Assoc. 1995 Sep; 45(9):
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is no significant correlation between X-ray lesions with [11]. Kim SJ et al. Incidence of pulmonary tuberculosis
reference to impaired glucose tolerance. Similar result ad among diabetics. Tuber Lung Dis. 1995 Dec; 76(6):
been reported by al-wahel et al (1997). But many authors 529-33.
reported that lower lobe involvement, cavitory changes [12]. Perez-Huzman et al. A typical radiological images of
were common in patients with glucose intolerance. In this pulmonary tuberculosis n 192 diabetic patients. Int J
study 70% (35) of patients had sputum positivity, out of 35 Tuber Lung Dis. 2001 May; 5(5): 455-61.
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11(22%) patients showed impaired glucose tolerance, none mycobacterial infection. 4th Edition. By Schlossberg.
of the sputum negative patients were showed impaired [14]. Definition and Diagnosis of Diabetes mellitus and
glucose tolerance. Statistical analysis showed significant Intermediate hyperglycemia – Report of WHO/IDF
correlation. Tamura et al and Lin S et al reported that consultation 2006
sputum positivity was higher among patients with diabetes
and time taken to in poorly controlled diabetes.
V. CONCLUSION