Endocrine Abstracts

Introduction: The world medical community is strongly concentrated on the fight against infectious diseases, such as COVD-19, HIV/AIDS and tuberculosis (TB), but non-communicable diseases diabetes and complications “have relatively imperceptibly come to the fore in developing countries, becoming a global problem.” The common multimorbidity disorders are evidence to suggest that, TB and vitamin D deficiency in patients with type 2 diabetes leads to disease clustering, frailty, and poor health-related quality of life.

Case report: A 62-year-old male has been suffering from type 2 diabetes for a long time complained of non-productive mild cough, low-grade fever, fatigue. A nasopharyngeal swab test for SARS-CoV-2 was negative. The patient consulted a tuberculotherapist. After the follow-up examination complete blood cell count, chest X-ray, sputum smear microscopy, genetic-molecular study with GeneXpert-test and culture test on the BACTEC system, the subject was diagnosed with disseminated TB with bacterial excretion, susceptible. The level of glycosylated hemoglobin (HbA1C) was 8.4%, glucose in the blood levels ranged from 3.2 to 15.4 mmol/l, 25-(OH)D₃ −9.2 ng/ml, that severe vitamin D deficiency. The patient received treatment according to the 2HRZE 4HR scheme. At the patient’s request, he continued to receive of antihyperglycemic drugs: metformin 2000 mg/day, sitagliptin 100 mg/day, but after one month therapy patient was given injection degludec/liraglutide at a daily dose of 10 units administered subcutaneously. The person is prescribed 20 000 IU/daily during 3 months. The result – the treatment was completed, whereas the cavern was preserved, the patient refused to undergo surgical treatment. After 3 months repeated laboratory tests were normal levels HbA1C was 7.1% without episodes of hypoglycemia and 25-(OH)D₃ −20.2 ng/ml. The therapy resulted in patient’s improvement of the general conditions and compensation of carbohydrate metabolism and vitamin D status.

Conclusion: Our clinical case suggests that the temporal relationship between significant deficiency vitamin D and the poor glycemic profile (HbA1C) in person with type 2 diabetes. TB programmes need to pay more attention to vitamin D status in the patients if there is coexisting diabetes. Particularly the association between vitamin D deficiency with prognosis of tuberculosis in patients with type 2 diabetes should be addressed through a future studies.