Extreme Glycemic Severity and Mortality Risk in the TB-DM Copandemic: A Retrospective Analysis of Clinical Outcomes
https://doi.org/10.15605/jafes.041.S1
- Author:
Mohammad Ulilamri Tukiman
1
;
Chitra Devi
1
;
Subramaniam
1
;
Yusniza Yusof
2
;
Mohammad Nur Syafiq Mohamad Azman
1
;
Choo Jia Qing
1
Author Information
1. Department of Internal Medicine, Hospital Sungai Buloh
2. Endocrine Unit, Department of Internal Medicine, Hospital Sungai Buloh
- Publication Type:Journal Article
- MeSH:
Retrospective Studies
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):36-37
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Tuberculosis patients with comorbid diabetes face a substantially higher risk of mortal outcomes. The “metainflammation” loop between hyperglycemia and tuberculosis (TB) infection exacerbates systemic severity and
increases hazard rates for death. This study aims to quantify
the association between baseline hemoglobin A1c (HbA1c)
levels and all-cause mortality within a Malaysian cohort.
Methodology:This was a retrospective cross-sectional audit analyzing
131 adult TB-DM (diabetes mellitus) patients during their
treatment course (2022–2025) in the TB Clinic, Hospital
Sungai Buloh. Primary outcomes were all-cause mortality
and clinical severity, stratified by baseline HbA1c and
diabetes mellitus DM treatment modality (OHA vs.
insulin).
Results:The overall mortality rate was 17% (22/131). A stark
disparity in glycemic control was observed between
survivors and deceased patients: those who died presented
with extreme mean HbA1c levels of 16.0%, compared to
10.5% in survivors. High HbA1c was also associated with a
higher prevalence of pulmonary involvement compared to
extrapulmonary disease (10.9% vs 8.9%). Patients requiring
insulin therapy experienced significantly higher mortality
rates compared to those managed on OHAs, with 25% (12
out of 47) patients requiring insulin therapy having died
during TB treatment, compared to only 8.2% (7 out of 84)
patients in the OHA-only group.
Conclusion:Baseline HbA1c is a critical prognostic marker that identifies
a high-risk “lethal threshold” at extreme glycemic levels
(HbA1c ≥16). Furthermore, the nearly fourfold increase in
death risk among insulin-treated patients likely reflects a
high-risk phenotype of advanced metabolic failure, which
corresponds with a study done in Kelantan (Siti Rohana
et al., 2020). The study shows that TB patients with DM
had three times higher risk of developing unsuccessful TB
treatment outcomes compared to TB patients without DM.
Collectively, these data necessitate mandatory early HbA1c
screening and aggressive metabolic management to reduce
the staggering mortality of this dual epidemic.
- Full text:2026072817243623245EP_A033.pdf
