There is no difference in treatment of TB between TB patients and Patients wih TB and DM.My colleagues and I have treated many patients with TB and TB+DM with standard regimen (6 and 9- month rgimens).

Mam thanks for your opinion. But what about the treatment of diabetes in TB. Can we continue oral hypoglycemic drugs the patient already receiving and started ATD or we shift to insulin therapy? If we have to continue oral hypoglycemic drugs then what should be the criteria for continuing and has HBA1C a role in that decision making?

Dear Arnab

Thank you. Yes, you can continue the oral agents as we did but In severely ill patients oral agent changes to insulin therapy and when the patient going well it shifts to oral agent .

Thank you Mam for your answer.

Can you kindly ellaborate the term "severely ill patient" in your answer? Is there any clear cut point beyond which we can start or we have to start insulin? If yes then kindly cite that guideline please.

Thank you.

Dear Arnab:

There is no a specific guideline to send it for you but, a 25 years experience with these patients showed the patients with following conditions including: Diffuse infiltrations in the lung, infiltration in two lobe or more, Dyspenea, Co-infection , having a complication of Diabete ( diabetic foot), Co-morbidity(TB+diabete and other disease) should receive Insulin and everytime the disease is controlled oral agent will be started.

Esentailly the treatment doesn't change. However one must take into account the interactions that the OHAs can have with the antitubercular drugs. Para-aminosalicylic acid can increase the hypoglycemic effects of sulfonylurea whereas rifampicin can reduce the levels of OHAs because of enzyme induction. Regarding substitution with insulin, that is true of any admitted and sick patient, not just the tubercular diabetic.

Rifampicin and isoniazid are too important for tuberculsis therapy that shoud be considered priority to achieve the cure and reduce the lengh of treatment. As the colleague said, insulin can be used to control DM and latter oral agents

Dear Colleagues,

Please, answer, there are bifunctional drugs for the treatment of TB and DMII?

Thank you for advance.