The impact of tuberculosis treatment on glycaemic control and the significant response to rosiglitazone

This case involves a 43-year-old female patient with highly uncontrolled type 2 diabetes for the past 14 years. Her weekly mean (SD) glycaemia (WMG) concentration at week 1 was 20.9 (4.8) mmol/l (377 (87) mg/dl). Four weeks after reaching full control at week 3 with insulin glargine plus regular insulin and metformin (WMG 7.0 (1.9) mmol/l (127 (34) mg/dl)) she was diagnosed with acute pulmonary tuberculosis and treated with rifampicin, isoniazid and pyrazinamide, which caused her to lose glycaemic control (WMG 21.0 (7.1) mmol/l (378 (128) mg/dl)). No other potentially hyperglycaemic drug such as corticosteroid was used. During this entire period she was intensively treated with NPH (neutral protamine Hagedorn) and regular insulins, reaching a total daily dose of 170 IU, but with no clinical response. Together with insulin therapy, rosiglitazone was started at week 12 and glycaemic control returned to normal within just 3 weeks (WMG 6.6 (2.9) mmol/l (120 (53) mg/dl)).