Pulmonary tuberculosis in diabetes: Exploring the intersection and impact on mental health

Table 1 Prevalence of mental health disorders in tuberculosis patients

Mental health disorder	Prevalence in DSTB patients	Prevalence in MDR-TB patients	Ref.
Depression	25%-50%	50%-70%	Huque et al[11], 2020; Srinivasan et al[21], 2021
Anxiety	20%-40%	40%-60%	Alene et al[3], 2018
Suicidal ideation	5%-10%	10%-20%	WHO[22], 2017; Srinivasan et al[21], 2021
Psychosis	< 5%	5%-10%	Doherty et al[5], 2013

WHO: World Health Organization; TB: Tuberculosis; MDR: Multidrug resistant; DSTB: Drug sensitive tuberculosis.

Table 2 Suggested approach for challenges in the management of tuberculosis with comorbid diabetes mellitus

Challenge	Suggested approach	Ref.
Delayed TB diagnosis in DM patients	Systematic TB screening in DM clinics	WHO 2023 Framework[37,38]
Poor TB treatment outcomes in DM	Aggressive glycaemic control; close follow-up during TB therapy	Huangfu et al[27], 2019
Drug-drug interactions affecting glycaemic control	Monitor blood glucose closely; adjust anti-diabetic medications	Restrepo[25], 2016
Rifampicin-induced hyperglycaemia	Increased SMBG (self-monitoring of blood glucose) during intensive phase	Restrepo[25], 2016
Lack of bi-directional screening at program level	Integrate DM screening in TB programs and TB screening in DM clinics	WHO 2023 Framework[37,38]
Poor patient adherence due to complex dual disease burden	Patient-centred care, education, counselling, and peer support	WHO 2023 Framework[37,38]
Lack of integrated clinical guidelines	Develop national guidelines on collaborative TB-DM management	WHO 2023 Framework[37,38]

TB: Tuberculosis; DM: Diabetes mellitus; WHO: World Health Organization.