6.3.4 Patients with diabetes mellitus

Currently, there are no specific changes in patients with diabetes; however, such patients may present cumulative risk factors for clinical complications, toxicities and drug–drug interactions. Good glycaemic control is considered essential while on TB treatment because such control optimizes the chance of cure and limits complications. The concomitant use of metformin at high doses and linezolid may increase the risk of lactic acidosis. Also, the long-term use of linezolid, high doses of isoniazid and cycloserine in patients with diabetes can lead to an increased risk of peripheral neuritis. Baseline optic nerve or retinopathy or maculopathy may worsen after linezolid use; hence, eye evaluation is recommended before and during treatment. Regarding potential baseline renal damage, amikacin and streptomycin should be used with caution. Patients with DR-TB and diabetes may need close follow-up and support, with quick identification of drug–drug interactions and adverse events.

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