Bernadette Dian Novita
Faculty of Medicine,University Surabaya, Indonesia
Dr. Bernadette Dian Novita is a medical doctor and lecturer in Widya Mandala Catholic University Surabaya Faculty of Medicine, her major is Pharmacology and Therapy, focusing in diabetes mellitus, infection and immunology. She has completed her PhD from Airlangga University Faculty of Medicine. She has got several national and international publications in diabetes mellitus area.
Poor glycemic control in Diabetes Mellitus (DM) patients has the potential to modify the risk of TB. In our knowledge, high glycemic index increases superoxide dismutase (SOD) for balancing oxidative stress – reactive oxygen species (ROS) production. Metformin (MET), one of glycemic control drug, has effect in increasing SOD level and expects to contribute in the Isoniazid (INH)-induced bactericidal by increasing activation of INH pro-drug. However, the optimal glycemic control during anti TB therapy in DM-TB infection remains unknown. An observational clinical study was done in DM-TB infection outpatients at Surabaya Paru Hospital. Glycemic index (HbA1c) evaluation was obtained during a 2-month MET therapy accompanying with insulin and anti TB. As a comparison, control group, whom were not given MET, was also evaluated. The smear was measured two times as diagnostic and as evaluation. Superoxide Dismutase (SOD) level were also evaluated before and after this observation period. From 42 participants in this study, 22 participants of observation group that received additional MET therapy, 100% had sputum smear reversion conversion after 2-months intensive phase of anti TB therapy. Whereas 25% of 20 participants of comparison group did not undergo reversion inserts sputum smear and needed additional anti TB . Smear reversion was significantly difference, using Fisher’s exact test, between the MET group and the control group. Moreover, SOD level was significantly different between MET group and the control group in HbA1c around 8,35%. Thus we concluded that MET is a potential additive therapy to enhance the bactericidal effect of anti TB on DM infected patients. Slightly poor-controlled glycemic index might contributed in enhanced anti TB activity. However, since the number of samples was limited in this study, cohort study need to be applied to support this data.
Keyword : type 2 diabetes mellitus-tuberculosis co-infection, metformin, AFB smear reversion, glycemic index and SOD