Arch Clin Infect Dis. 2021 April; 16(2):e99260. Published online 2021 June 16. doi: 10.5812/archcid.99260. Research Article Eﬀect of Diabetes Mellitus on Renal and Audiology Toxicities in Patients with Drug-Resistant Pulmonary Tuberculosis Soedarsono Soedarsono 1, * , Tutik Kusmiati 1 and Ariani Permatasari 1 1 Department of Pulmonology and Respiratory Medicine, Universitas Airlangga, Surabaya, Indonesia * Corresponding author: Department of Pulmonology and Respiratory Medicine, Universitas Airlangga, 60131, Surabaya, Indonesia. Tel: +62-8113446702 Email: ssoedarsono@gmail.com Received 2019 November 09; Revised 2021 April 23; Accepted 2021 April 25. Abstract Background: People with diabetes mellitus (DM) have a higher risk for drug-resistant tuberculosis (DR-TB). DR-TB patients with comorbidity of DM were also vulnerable to experience adverse eﬀects of DR-TB treatment. Management of DR-TB with comorbidity of DM is complicated. Also, DM may aﬀect TB response treatment and cause more adverse eﬀects. Objectives: This study was conducted on DR pulmonary TB (DR-PTB) patients to evaluate the eﬀect of DM on adverse eﬀects, espe- cially renal function impairment and audiology impairment, as well as treatment outcomes due to treatment regimens containing kanamycin. Methods: A retrospective study was conducted from 2016 to 2017 at Dr. Soetomo Hospital. Patients who received DR-TB regimens containing kanamycin were included in this study. HbA1c >7 was used to deﬁne DM. The adverse eﬀects in this study were impaired renal function (increased serum creatinine) and audiology impairment. Results: Patients who experienced increased serum creatinine were 28/82 (34.1%) with DM and 20/120 (16.7%) without DM, audiology impairment were 22/82 (26.8%) with DM and 19/120 (15.8%) without DM, and unfavorable outcome were 37/82 (45%) with DM and 46/120 (38%) without DM. Moreover, DM is associated with adverse eﬀects and treatment outcomes. Patients with DM have a risk ratio (RR) for increased serum creatinine, audiology impairment, and unfavorable outcome with RR 2.049 (95% CI: 1.242 – 3.379), RR 1.694 (95% CI: 0.982 – 2.925), and RR 1.177 (95% CI: 0.847 – 1.636), respectively. Conclusions: Diabetes mellitus increases the risk of adverse eﬀects, increased serum creatinine, and audiology impairment. Also, it increases the risk of unfavorable treatment outcomes in patients with DR-PTB who receive DR-TB regimens containing kanamycin. Keywords: Drug-Resistant Pulmonary Tuberculosis, Diabetes Mellitus, Adverse Eﬀects 1. Background Multidrug-resistant tuberculosis (MDR-TB) is a public health crisis. Indonesia is one of 30 countries with the highest MDR/RR-TB cases in the world, with the number of incidences of MDR/RR TB 23,000 and the percentage of MDR TB is 91% (1). Drug-resistant tuberculosis (DR-TB) cases in Dr. Soetomo Hospital were 90 cases in 2012, 143 cases in 2013, 142 cases in 2014, and 140 cases in 2015 (2). The treat- ment of MDR-TB is challenging, especially for patients with comorbidities. The incidence of diabetes mellitus (DM) is increasing globally (3). People with diabetes mellitus (DM) have a higher risk for DR-TB infection. Among patients with MDR-TB, DM is a common comorbidity, which was reported to be corre- lated with an increased risk of treatment failure and death in MDR-TB-treated patients and followed for 8–11 years (4). Comorbidity of DM in MDR-TB treatment causes the worse adverse eﬀect and treatment outcomes, increases the cost of treatment, promotes the MDR-TB transmission, and can also generate extensively drug-resistant TB (XDR-TB) (5). Diabetes mellitus may aﬀect TB response treatment and cause more adverse eﬀects. In some cases, adverse eﬀects cause a changed DR-TB regimen and can also cause perma- nent discontinuation of the drug used due to adverse ef- fects (6). A greater bacillary load at the baseline was found in pa- tients with DR-TB having comorbidity of DM, which caused a longer time to culture conversion. Diabetes mellitus caused a change in drug absorption and impaired renal or liver function in drug clearance (7). It may be hypothesized that DR-TB with DM increased the risk of an unfavorable outcome. Many studies from diﬀerent countries suggested that there is a signiﬁcantly higher risk of unfavorable out- comes in patients with DR-TB and DM (3, 4, 8, 9), while other studies reported diﬀerent results that there was no corre- Copyright © 2021, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.