Analysis of the influencing factors and clinical related characteristics of pulmonary tuberculosis in patients with type 2 diabetes mellitus

Clinical, metabolic, and immune interaction between tuberculosis and diabetes mellitus: implications and opportunities for therapies

INTRODUCTION

Tuberculosis (TB) remains a major infectious threat to global health, while type 2 diabetes mellitus (diabetes) has reached epidemic proportions in many regions of the world. In low- and middle-income countries (LMIC) and among indigenous and minority communities in high-income settings (HIC), these diseases also increasingly overlap, posing new clinical and therapeutic challenges.

AREAS COVERED

We searched PubMed/CINAHL/Web of Science/Scopus, Google Scholar up to 30 November 2024. Meanwhile, the Immuno-metabolic parallels between TB and Diabetes are underappreciated. Improved understanding of mechanisms may pave the way for novel therapeutic strategies, for example, using antidiabetic medications as adjuvant host-directed therapies (HDT) in active TB. We review the epidemiology of TB, diabetes and their combined comorbidity, their immune and metabolic mechanisms and clinical relevance, as well as potential opportunities for general and targeted therapeutic intervention.

EXPERT OPINION

Immunometabolic interaction between diabetes and tuberculosis is bidirectional. Underlying this interaction are shared inflammatory mechanisms. It follows that treatments for diabetes and its complication may be beneficial in tuberculosis and that the treatment of both active and latent tuberculosis may improve glycemic control. These interactions are amenable to investigation in experimental models, in human experimental medicine studies and in clinical trials.

Research on the effects of different sugar substitutes-Mogroside V, Stevioside, Sucralose, and Erythritol-On glucose, lipid, and protein metabolism in type 2 diabetic mice

Sugar substitutes that maintain the homeostasis of glucose, lipid, and protein metabolism are important for nutritional intervention in type 2 diabetes mellitus (T2DM). However, the specific metabolic effects remain unclear. The aim of this study was to systematically compare the effects of four common sugar substitutes on a high-fat diet (HFD) combined with a streptozotocin (STZ)-induced T2DM mouse model from the perspective of hepatic glucose, lipid, and protein metabolism. In this study, based on the establishment of a T2DM mouse model induced by an HFD combined with STZ and nontargeted metabolomics, the effects of four sugar substitutes on regulating and improving sugar, lipid, and protein metabolism were systematically evaluated. The results showed that mogroside V (MOG), stevioside (ST), and erythritol (ERT) enhanced protein synthesis via the mammalian target of the rapamycin/p-P70S6K pathway. MOG and ST also improved glucose and lipid metabolism by activating the phosphor-AMP-activated protein kinase (p-AMPK) pathway and upregulating peroxisome proliferator-activated receptor alpha/carnitine palmitoyltransferase 1. Sucralose primarily improves lipid metabolism by downregulating sterol regulatory element-binding protein 1, whereas ERT increases lipid droplet accumulation in the liver. These findings provide a foundation for the application of sugar substitutes in T2DM nutritional interventions.

Diabetes and tuberculosis: An emerging dual threat to healthcare

Tuberculosis (TB) remains a huge global healthcare challenge even in the 21st century though the prevalence has dropped in developed countries in recent decades. Diabetes mellitus (DM) is an important risk factor for the development and perpetuation of TB owing to the immune dysfunction in patients with DM. The coexistence of both diseases in the same individual also aggravates disease severity, complications, and chance of treatment failure because of gross immune alterations posed by DM as well as TB. Various complex cellular and humoral immunological factors are involved in the dangerous interaction between TB and DM, some of which remain unknown even today. It is highly important to identify the risk factors for TB in patients with DM, and vice versa, to ensure early diagnosis and management to prevent complications from this ominous coexistence. In their research study published in the recent issue of the World Journal of Diabetes, Shi et al elaborate on the factors associated with the development of TB in a large cohort of DM patients from China. More such research output from different regions of the world is expected to improve our knowledge to fight the health devastation posed by TB in patients with diabetes.