Call to action to halt the looming TB-diabetes co-epidemic

Babs Verblackt, CNS Special Correspondent
Dr Anthony Harries, The Union (L),
Dr Anil Kapur, WDF (R)
It is time to act and no time to waste. That is the urgent message of the report "The Looming Co-epidemic of TB-Diabetes: A Call to Action" launched jointly by the International Union Against Tuberculosis and Lung Disease (The Union) and the World Diabetes Foundation (WDF) at the opening day of the 45th Union World Conference on Lung Health in Barcelona. The report warns against the brewing storm of diabetes and tuberculosis (TB) that is no longer confined to the teacup.

People with diabetes have a three times greater risk of contracting TB than those without diabetes. People with TB have high rates of diabetes that often go undiagnosed.

Diabetes is on the rise globally, and is projected to increase from 382 million cases in 2013 to 592 cases in 2035. Also the burden of the disease is moving from developed countries to developing and emerging-market countries. 6 of the top 10 countries projected to have the greatest number of people living with diabetes in the year 2035 are also classified as high TB burden countries by the World Health Organization (WHO). These countries include China, India, Brazil, Indonesia, Pakistan and the Russian Federation.

The report lists recommendations for practical action on policy, programme implementation, financing and technical assistance, health service delivery, and advocacy level.

Interaction with an impact
"The burden of diabetes continues to grow while the decline in TB has been slowed down. The interaction between TB and diabetes may further impact the decline in TB. If action is not taken to address the double burden of TB and diabetes the gains in control and containment of TB may get undone," Dr Anil Kapur, member of the Board of Directors of the World Diabetes Foundation told Citizen News Service (CNS).

"In places where this issue has been studied - from India to China to East-Africa and the United States – we are seeing significantly higher rates of diabetes among TB patients than what appears in the general population. If we do not act now to head this off, we are going to experience a co-epidemic of TB-diabetes that will impact millions and sap public health systems of precious resources. The key is to prevent this from happening," he said.

Action on the ground
This timely report on the looming co-epidemic synthesizes evidence from the medical and scientific literature, promotes an international policy framework for action, and lays out a new research agenda to fill knowledge gaps.

"This report brings attention to the threat posed by this double burden amongst the different stakeholders and calls for enhancing the implementation of the Collaborative Framework through real action on the ground and increasing resources to address the issue," Kapur said, referring to the The Collaborative Framework for Care and Control Of TB and Diabetes. This document, published by the WHO and The Union in 2011, provides evidence-based, practical guidance for policymakers and health programme implementers to address the growing epidemic of diabetes and TB. 

Conventional approach challenged
Dr Anthony Harries, The Union (L),
Dr Anil Kapur, WDF (R)
Tuberculosis is an airborne, infectious disease caused by bacteria. Diabetes is a chronic illness that weakens the immune system, making people with diabetes more susceptible to developing TB. The report challenges the conventional approach to health policy making, which has historically addressed infectious diseases and noncommunicable or chronic diseases independently.

Dr Anthony Harries, Senior Advisor to The Union, calls the launch of the report 'very timely'. "The WHO has recognized the link between diabetes and TB and has incorporated management of diabetes into its post-2015 global strategy to decrease TB incidence by 90% by 2035," Harries told Citizen News Service. "This intersection between communicable diseases (TB) and noncommunicable diseases (diabetes) can also be used as a driver to strengthen health care systems with a focus on universal health coverage," he added.

Learning from TB-HIV
According to Harries the 'most interesting elements' of the report are the recommendations for practical action. Drawing upon the lessons learnt about the previous slow response to the HIV-TB epidemic 25 years ago, he explained that, "We saw something similar happen with TB and HIV/AIDS to what is happening now with TB and diabetes. For years we had medical evidence that the two diseases were working together as HIV destroyed people's immune systems, allowing TB to quadruple in many countries in Africa. And for years we had a policy framework for responding. But it took years to mobilize a robust response, and millions of people were impacted by TB-HIV co-infection before it became the norm to screen people living with HIV for TB and vice-versa. We want to raise an alarm that we do not watch history repeat itself with TB-diabetes."

Screening and more
One of the report's major recommendation is for healthcare systems to begin offering bi-directional screening, where people with TB are screened for diabetes and people with diabetes are screened for TB, and then offered appropriate treatment services. 

But additional steps are also needed to halt the looming co-epidemic. Harries underscored that the knowledge from the report should be translated into "more country level action, better structured monitoring of diabetes, more operational research and more basic science research to understand the linkage between diabetes and TB better".

"We should be aware that the TB epidemic and the diabetes epidemic are intersective. We need to wake up and do something about it," Harries concluded.

Photo credit: Babs Verblackt/ CNS

Babs Verblackt, Citizen News Service - CNS
29 October 2014
(The author is reporting from the 45th Union World Conference on Lung Health for Citizen News Service (CNS) with support from the Global Alliance for TB Drug Development (TB Alliance). Email: babs@citizen-news.org)

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