Editor–We read with great interest the article by Bailey and colleagues (Clin Med August 2011 pp 344–7). Treatment of people with tuberculosis (TB) and diabetes is indeed complicated. Not only does rifampicin potentially adversely alter the pharmacokinetics of gliclazide,1 glipizide,2 pioglitazone,3 nateglinide4 and repaglinide,5 but like isoniazid, it may increase insulin requirements.6 Liver and nerve toxicity from anti-TB drugs may be difficult to distinguish from diabetes-associated non-alcoholic fatty liver disease and peripheral neuropathy respectively and for those with co-morbid HIV infection with access to treatment, there is the added complication of antiretroviral-associated insulin resistance.7 TB itself may precipitate hyperglycaemia by a stress hormone response and there is some evidence of glucose intolerance in TB patients reverting to normal in up to 75% of patients after three months of TB treatment.8
We wholeheartedly endorse Bailey and Grant's conclusion that TB and diabetes demand increased attention from clinicians and academics if we are to ensure that future patients receive optimal management of both conditions.
Footnotes
Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk
- © 2011 Royal College of Physicians
References
‘The tubercular diabetic’
We read with appreciation the comments of Chandrasekara and Hardy. The management of concomitant tuberculosis and diabetes mellitus remains challenging and highlights two important factors. Firstly, that our level of clinical suspicion of dual pathology here in the UK needs to be raised so that management can be optimised, including appropriate adjustment and monitoring of medication. Secondly, that as diabetes progresses in low-income countries we need to consider collectively how best to manage this chronic disease in resource-limited settings and indeed this is a focus of our ongoing research.
Footnotes
Please submit letters for the editor's consideration within three weeks of receipt of Clinical Medicine. Letters should ideally be limited to 350 words, and sent by email to: clinicalmedicine{at}rcplondon.ac.uk
- © 2011 Royal College of Physicians
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