Co-Infection of Tuberculosis and Diabetes: Implications for Treatment and Management

Background: Tuberculosis (TB) and diabetes mellitus (DM) are two major public health concerns, particularly in low- and middle-income countries. The co-existence of these conditions complicates treatment outcomes and increases morbidity and mortality. Despite the growing burden of TB-DM co-infection, data on its clinical profile, treatment adherence, and associated risk factors in Bangladesh remain limited. Objective: This study aims to assess the sociodemographic characteristics, clinical profiles, treatment adherence, and predictors of poor treatment outcomes among elderly TB patients with diabetes in Bangladesh. Methods: A cross-sectional study was conducted at the Ad-din Barrister Rafique-ul Huq Hospital, Dhaka, from January to December 2023. A total of 130 TB patients aged ≥60 years with co-existing diabetes were included. Data were collected from Ad-din Medical College and Hospital, Magbajar, Dhaka through structured interviews, medical record reviews, and laboratory investigations. Descriptive statistics, chi-square tests, and logistic regression were performed to identify significant associations, with a p-value of <0.05 considered statistically significant. Results: The majority of participants were male (64.6%) and aged 60-64 years (32.3%). 64.6% of patients had uncontrolled diabetes (HbA1c ≥7.0%), and 20.8% had multidrug-resistant TB (MDR-TB). Hypertension (54.6%) and cardiovascular disease (32.3%) were the most common comorbidities. Poor treatment adherence was observed in 29.2% of patients, which was significantly associated with unfavorable treatment outcomes (p<0.001). Logistic regression revealed that MDR-TB (AOR: 5.01, p<0.001) and uncontrolled diabetes (AOR: 4.12, p<0.001) were the strongest predictors of poor outcomes. Conclusion: TB-DM co-infection is associated with high rates of poor glycemic control, MDR-TB, and treatment non-adherence, leading to adverse outcomes. Integrated management strategies focusing on early detection, glycemic control, and adherence counseling are crucial for improving patient outcomes.