Diabetes and Tuberculosis

  • Blanca I. RestrepoEmail author


The worldwide increase in the prevalence of diabetes has been most notable in TB-endemic countries and has led to the re-emerging importance of the association between these two diseases. Today, type 2 diabetes is one of the most prevalent comorbidities and risk factors in TB patients, along with undernutrition and HIV/AIDS. However, it is striking how little we know about the underlying biology of the association between TB and diabetes. In this chapter, I first provide an overview of the epidemiology and characteristic clinical findings associated with patients who have both diseases. Then I review the current knowledge on underlying biology on the association. Essentially, studies in animal models of diabetes and TB and ex vivo studies with immune cells from patients with diabetes suggest a model where the initial Mycobacterium tuberculosis infection in the diabetic host is characterized by a delayed and underperforming response by monocytes and macrophages. These defects provide a critical early opportunity for favorable replication of M. tuberculosis within the diabetic alveolar macrophages. Eventual but delayed T-cell priming does occur, and in TB patients, this T-cell response is exaggerated, perhaps as a reflection of higher M. tuberculosis burden in TB with diabetes (vs. TB with no diabetes). The metabolic alterations characteristic of diabetes (e.g., chronic hyperglycemia, metabolic inflammation [meta-inflammation], oxidative stress) are likely to contribute to the immune dysfunction to mycobacteria. The discovery of these mechanisms is providing the knowledge base to design host-directed therapies for TB patients with diabetes, and perhaps those without diabetes as well.


Tuberculosis Diabetes Immunity Epidemiology Clinical Public health 


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© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.UTHealth Houston, School of Public HealthBrownsvilleUSA

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