INSULIN RESISTANCE IN PATIENTS WITH NEWLY DIAGNOSED PULMONARY TUBERCULOSIS WITH DIFFERENT TREATMENT OUTCOME

Abstract

The aim of the study – to evaluate fasting glucose, insulin levels and homeostasis model assessment (HOMA-IR) index in patients with newly diagnosed pulmonary tuberculosis treatment failure (TFT) compared to data of patients who have successfully completed course of treatment (NDT).

Materials and methods. 49 newly diagnosed pulmonary tuberculosis patients were examined. Patients were divided into 2 groups. Group 1 included 28 patients with TFT. Group 2 (comparison group) included 21 NDT patients. Blood sampling in the patients was done before treatment, after 3 months of the treatment start and after 2–3 months of treatment of patients in the group 1. Fasting plasma glucose level was determined by the hexokinase method by using Beckman Coulter AU640 biochemical analyzer, Japan. Fasting serum insulin level was determined by electrochemiluminescence method on Cobas e411 analyzer, Switzerland. Insulin resistance index was calculated by HOMA-IR by Matthews et al., 1985.

Results. Fasting glucose levels were normal and almost similar in both groups before and after treatment, p˃0.05. Fasting insulin levels were also normal, but they were higher in patients of the group 1 than in the group 2, p˂0.05. It means there was a relative slight hyperinsulinemia in TFT patients. HOMA-IR index was also significantly greater among patients in the group 1, p˂0.05. Fasting glucose levels increase was in 10.7 % of patients in the group 1 and in 4.8 % patient in the group 2. Decrease of glucose levels was in 4.8 % of patients from the group 2. Fasting insulin levels increase was determined in 1 case among the group 1 patients and there were not cases with increased insulin levels among the patients of the group 2; fasting insulin levels reduction was identified in 14.3 % of patients from the group 1 only, p˃0.05. There was HOMA-IR index increase among patients of the group 1 mostly: 9 cases (33.3 %) versus 1 case (4.8 %) in the group 2, p˂0.05. Thus, a relative slight hyperinsulinemia in normal glucose levels and HOMA-IR index increase could be a signs of preclinical disorders of carbohydrate metabolism in patients with TFT.

Conclusion. It may indicate negative impact of virulent mycobacteria and more severe clinical and radiological changes on carbohydrate metabolism or/and negative impact of such disorders to prognosis of tuberculosis.