PROJECT SUMMARY The intersection of tuberculosis (TB) with non-communicable diseases, including diabetes mellitus, has emerged as a critical clinical and public health obstacle. Rapidly expanding diabetes epidemics threaten TB control in low- and middle-income countries, including the country of Georgia, where preventing and treating TB disease remains a great burden. However, to date, the notion that TB disease may increase the risk of metabolic diseases like diabetes has not been well explored. This study will determine the extent to which TB-induced stress hyperglycemia impacts the risk of poor TB treatment outcomes. We will also assess whether stress hyperglycemia or adipose tissue inflammation during TB increase the risk of diabetes post-TB. This research will advance understanding of dual burdens of TB-diabetes and inform treatment guidelines for management of stress hyperglycemia during TB. The long-term objective of this research is to develop an evidence base to help identify which patients with TB are likely to benefit most from adjunctive anti-inflammatory glucose-lowering agents. The specific aims of this proposal are to: (1) determine the relationship between stress hyperglycemia and TB outcomes, including TB cure rate and time to sputum culture conversion; (2) determine the extent that stress hyperglycemia during TB increases the risk of diabetes 1-year after TB treatment; and (3) explore the relationship between plasma and subcutaneous tissue biomarkers of adipose tissue inflammation with stress hyperglycemia and diabetes risk. The aims of this project will be achieved by enrolling a cohort of patients at the time of TB diagnosis and following them prospectively during treatment and for 1-year post-TB treatment. At multiple time points during this study we will measure glucose, insulin resistance, lipids, adipokines, and anthropometry among participants with diabetes, stress hyperglycemia, and euglycemia. In a subset of the cohort we will perform adipose tissue biopsies and measure adipose tissue inflammation. The analyses will include multiple modeling strategies to assess the relationship between patient and host factors and the risk of post-TB metabolic disease. This proposal will directly address clinical uncertainties related to the growing global concern of intersecting TB and diabetes epidemics. The study will help to characterize the extent to which TB contributes to diabetes incidence and will identify which patients with hyperglycemia are at greatest risk of poor TB outcomes. In addition, this R01 will explore novel biomarkers of adipose tissue inflammation to determine whether TB alters immune activity or metabolic function within human adipose tissue. A long-term goal of the proposed work is to prepare for prospective interventional studies that will evaluate glucose-lowering agents during active TB as adjunctive therapy to improve TB outcomes and reduce risk of diabetes after TB.

PROJECT NARRATIVE Tuberculosis (TB) disease causes chronic inflammation and requires at least 6-months of treatment. In this proposal, we will characterize the impact of TB on stress hyperglycemia and risk of diabetes mellitus after TB treatment ends. Our results will improve understanding of how inflammation and diabetes interact to impact both TB treatment and metabolic health outcomes for patients with TB disease.