The Bidirectional Relationship between Tuberculosis and Diabetes

The burden of tuberculosis (TB) especially in developing countries continues to remain high despite efforts to improve preventive strategies. Known traditional risk factors for TB include poverty, malnutrition, overcrowding, and HIV/AIDS; however, diabetes, which causes immunosuppression, is increasingly being recognized as an independent risk factor for tuberculosis, and the two often coexist and impact each other. Diabetes may also lead to severe disease, reactivation of dormant tuberculosis foci, and poor treatment outcomes. Tuberculosis as a disease entity on the other hand and some commonly used antituberculous medications separately may cause impaired glucose tolerance. This review seeks to highlight the impact of comorbid TB and diabetes on each other. It is our hope that this review will increase the awareness of clinicians and managers of TB and diabetes programs on the effect of the interaction between these two disease entities and how to better screen and manage patients.