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      Tuberculosis and Diabetes Mellitus, Tackling Dual Maladies: Comment on Bangladeshi Tuberculosis-diabetes Mellitus Guidelines

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      Indian Journal of Endocrinology and Metabolism
      Medknow Publications & Media Pvt Ltd

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          Abstract

          The national guidelines issued from Bangladesh on the management of diabetes mellitus (DM) in patients who contract tuberculosis (TB) is a reference document for physicians and would aid in the effective management of these patients.[1] Further, the article touches on the hurdles in diagnosing TB in patients with diabetes due to atypical presentations and on the negative effects of these diseases on each other. While the authors have covered routine management of DM, stressing the importance of glycemic goals, there are few other aspects which need to be highlighted while treating such patients. The first of these is the use of steroid therapy for 6 weeks or longer in patients with tubercular meningitis and pericarditis. Some of the patients with diabetes may have a worsening of glycemic control while on therapy while a few diabetes-naïve patients may develop steroid-induced hyperglycemia.[2] Both these conditions may need appropriate management with the probable initiation of insulin therapy. When the steroid is stopped, there is also a chance of iatrogenic adrenal insufficiency which may lower blood glucose levels. The second issue is the steroid insufficiency resulting from rifampicin use, especially in those with underlying adrenal involvement.[3] Here, the treating physicians must be cautious of low levels of blood glucose that may ensue. In addition, as antitubercular therapy can alter the metabolism of oral antidiabetic drugs the authors have suggested switching on to insulin therapy. Third, quinolones used as second-line therapy also may also precipitate hypoglycemia.[4] Vitamin D deficiency which has been implicated in both insulin resistance and poor cure rates of TB also needs a mention in this context.[5] There may be a case toward treating and maintaining Vitamin D at sufficiency levels in these patients. The duration of antituberculous therapy in patients with diabetes is currently as recommended for standard therapy. Well-designed studies evaluating the complications and prognosis of patients with these dual diseases should investigate the need for longer or stronger antitubercular therapies. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

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          Most cited references5

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          Vitamin D in the treatment of pulmonary tuberculosis.

          Vitamin D was used to treat tuberculosis in the pre-antibiotic era. New insights into the immunomodulatory properties of 1alpha,25-dihydroxy-vitamin D have rekindled interest in vitamin D as an adjunct to antituberculous therapy. We describe the historical use of vitamin D in tuberculosis treatment; discuss the mechanisms by which it may modulate host response to infection with Mycobacterium tuberculosis; and review three clinical trials and ten case series in which vitamin D has been used in the treatment of pulmonary tuberculosis.
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            Tuberculosis of the Adrenal Gland: A Case Report and Review of the Literature of Infections of the Adrenal Gland

            Infections of the adrenal glands remain an important cause of adrenal insufficiency, especially in the developing world. Indeed, when Thomas Addison first described the condition that now bears his name over 150 years ago, the vast majority of cases were attributable to tuberculosis. Here we describe a classic, but relatively uncommon, presentation in the United States of adrenal insufficiency followed by a review of the current literature pertaining to adrenal infections.
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              HOSPITAL INSULIN PROTOCOL AIMS FOR GLUCOSE CONTROL IN GLUCOCORTICOID-INDUCED HYPERGLYCEMIA.

              To compare the effectiveness of 2 insulin protocols to treat glucocorticoid-induced hyperglycemia in the nonintensive care hospital setting.
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                Author and article information

                Journal
                Indian J Endocrinol Metab
                Indian J Endocrinol Metab
                IJEM
                Indian Journal of Endocrinology and Metabolism
                Medknow Publications & Media Pvt Ltd (India )
                2230-8210
                2230-9500
                Mar-Apr 2017
                : 21
                : 2
                : 359
                Affiliations
                [1]FRCP, Speciality Certificate in Endocrinology, Internal Medicine and Clinical Ethics, St. John's Medical College, Bengalore, Karnataka, India
                Author notes
                Address for correspondence: Dr. Jyothi Idiculla, MD, FRCP, Speciality Certificate in Endocrinology, Professor, Internal Medicine and Clinical Ethics, St. John's Medical College, Bangalore - 560 034, Karnataka, India. E-mail: jyothi_idiculla@ 123456yahoo.co.in
                Article
                IJEM-21-359
                10.4103/ijem.IJEM_465_16
                5367243
                2f3c19d7-3064-4db2-bf57-25f0e7cc020c
                Copyright: © 2017 Indian Journal of Endocrinology and Metabolism

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

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                Letters to the Editor

                Endocrinology & Diabetes
                Endocrinology & Diabetes

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