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dr Em Yunir
dr. Andra Aswar
TUBERCULOSIS
www.who.int/tb & DIABETES
COLLABORATIVE FRAMEWORK FOR
CARE AND CONTROL OF TUBERCULOSIS AND DIABETES
TUBERCULOSIS FACTS:
More than 9 million people fall
sick with tuberculosis (TB) every
year
Over 1.5 million die from TB
every year, which the vast majority
of deaths in the developing world
One in three people in the world
is infected with latent TB. People Estimated
infected with latent TB have a tuberculosis
lifelong risk of developing and incidence,
falling sick with active TB by country,
2009
13.2 % 3.2 %
DM +
(60/454) (18/556)
Diabetes" No"diabetes"
CharacterisPca" (n"="86)" (n"="147)" P"
Country"of"enrolment" 0.65"
United"States" 24"(28)" 37"(25)"
Mexico" 62"(72)" 110"(75)"
Age"Mean"("SD)" 49.9"(13)" 40.3"(17)" <"0.0001"
Female"gender" 32"(37)" 42"(29)" 0.17"
EducaPon" 0.70"
None" 13"(15)" 18"(12)"
Elementary"or"middle"school" 57"(66)" 96"(65)"
High"school"or"higher" 16"(19)" 33"(22)"
Employed" 53"(62)" 103"(70)" 0.19"
BMI" 0.0001"
Underweight" 10"(12)" 36"(25)"
Normal"weight" 42"(50)" 87"(60)"
Overweight/obese" 32"(38)" 23"(16)"
Alcohol"abuse" 9"(11)" 32"(22)" 0.03"
Drug"abuse" 11"(13)" 40"(27)" 0.01"
History"of"incarceraPon" 2"(2)" 13"(9)" 0.06"
HIV+" 0"(0)" 9"(6)" 0.03"
References:" ,"2011;"89(5):"352V359."
The Effect of T2DM on the Presentation and Treatment
Response of Pulmonary Tuberculosis
Urban Setting in Indonesia, 737 pulmonary TB were screened for DM using FPG and
were followed up prospectively
Diabetes"Affects"AnP\tuberculosis"Drugs" Tuberculosis"Affects"AnP\diabetes"
Drugs"
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47"
Tuberculosis Among Diabetes Patients in
Endocrinology Outpatient Clinic of RSCM*
Retrospective Data from Medical Records 2003-2004
n=1893 (1255 completed)
Patients with DM who are found to have LTBI should be encouraged to take
INH for 9 months
Patients with DM on INH should receive vitamin B6 to prevent INH
induced neuropathy
Screening for DM in persons with TB
Every patient with TB over the age of 18 should be screened for
DM
A fasting plasma glucose > 126 mg/dl = DM
A random plasma glucose > 200 mg/dl = DM
A Hemoglobin A1c > 6.5% = DM
Diabetes"Affects"AnP\tuberculosis"Drugs" Tuberculosis"Affects"AnP\diabetes"
Drugs"
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51"
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Tabel 1. Hal hal yang perlu dipantau
Yang dipantau Waktu Pemeriksaan
Tinggi dan BB Setiap kunjungan
BMI Setiap kunjungan
Pemantauan Setelah pengobatan TB bulan ke 2, ke 5 dan Akhir
Pengobatan
Latihan jasmani Setiap 3 bulan
Diet Setiap kunjungan
HbA1 C Awal diagnosis
Tiap 6 bulan sekali
Merokok Setiap kunjungan
GDP Setiap kunjungan
G 2 jam PP Setiap kunjungan
Periksa profil lemak (TC, Awal diagnosis
HDL, TG and calculated Bila belum ada kelainan diulangi setiap tahunnya.
LDL) Bila sudah ada dislipidemia dilakukan evaluasi ulang
setiap 3 bulan
Pemeriksaan mata DM tipe 2 dilakukan saat diagnosa bila tidak ada
kelainan diulang setiap 1-2 tahun sekali.
Bila ditemukan kelainan maka interval follow up
ditentukan oleh spesialis mata sesuai dengan berat
ringannya kelainan
Pemeriksaan proteinuria DMTipe 2 dilakukan saat diagnosa ditegakan bila tidak
(mikroalbuminuria) dan ada kelainan diulangi setiap tahun sekali
serum kreatinin yg Ditemukan adanya kelainan interval follow up
dikonversikan ke GFR. ditentukan oleh spesialis penyakit dalam sesuai dengan
berat ringannya kelainan
Pemeriksaan Neuropati DM tipe 2 dilakukan saat diagnosa ditegakan kemudian
bila tidak ada kelainan diulangi tiap 1-2 tahun sekali.
Bila ditemukan adanya neuropati maka interval follow
up ditentukan oleh spesialis sesuai dengan berat
ringannya kelainan
Pemeriksaan ECG Pemeriksaan ECG awal dan diulang tiap 1 tahun sekali
Apabila ditemukan kelainan diulang setiap 6 bulan