23 2 Tuberculosis treatment and abnormal blood glucose. Introduction The World Health Organization estimates that ten million people were infected with tuberculosis (TB) in 2020, with 1.5 million deaths in the same year [1]. Concurrently, the International Diabetes Federation estimates that 537 million adults aged 20 to 79 were living with diabetes mellitus (DM) in 2021, with 75% of these residing in low- and middleincome countries (LMICs) [2, 3]. An estimated 6.7 million people died from DM in 2021, with rising cases of type 2 diabetes mostly from LMICs [2, 3]. Different studies indicate that people with DM are more likely to develop TB with worse treatment outcomes when receiving treatment for TB [4-7]. Therefore, understanding the blood sugar changes in patients during TB treatment is essential to ensure good treatment outcomes. Globally the prevalence of TB amongst DM patients is estimated to be 15.3% [8]. This prevalence varies depending on the age and sex of the population, the burden of DM and TB in the population and human development index scores [8]. The prevalence of DM in active TB is highest in North America and the Caribbean (19.7%), Western Pacific (19.4%) and Southeast Asia (19.0%) compared with Africa (8.0%) [8]. A prevalence of 15%, 11% and 10% has been documented in Nigeria, Tanzania and Ethiopia, respectively [9]. While numerous studies indicate that diabetes is a risk factor for TB, it is not completely clear if TB or its treatment predisposes one to develop DM [10-12]. Available explanation points to an impaired glucose tolerance (IGT) during treatment with anti-TB drugs, which may or may not resolve once the treatment is completed [11, 13-17]. This IGT is thought to be due to underlying undiagnosed diabetes or stress response from infection, resulting in increased levels of stress hormones, interleukin-1, interleukin-6 and TNF-alpha, abnormal functioning of the pancreas and possible TB-induced pancreatitis offsetting endocrine function [10, 11, 18]. Though plausible, these explanations have not been fully verified. Also, a high TB burden has been associated with human immunodeficiency virus (HIV) infection, which results in an immunocompromised state. So, HIV co-infection in TB patients may result in varied immune and endocrine responses with untoward outcomes. Although studies describing the effect of TB treatment on blood glucose are available, these are few in Africa and other LMICs. Additionally, DM-TB studies in resource-poor settings with high HIV burden are required to understand the intersection with HIV. Some available studies have methodological limitations such as small sample size and short follow-up post-TB treatment [19-21] and were conducted before the HIV epidemic. A search of PubMed and the Joanna Briggs Institute (JBI) Database of Systematic Reviews and Implementation Reports conducted on 25 July 2021 indicates few review articles and a systematic review protocol are available [10, 18, 22]. No scoping reviews were identified. The review articles presented useful information on the possible aetiology of abnormal glucose during TB treatment but none on the predictors. The available studies
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