TB-Diabetes: the looming co-epidemic

Carolyn Kavita Tauro, CNS Special Correspondent
Dr A Harries (L), Dr A Kapur (R)
On the opening day of the 45th Union World Conference on Lung Health, “The Looming Co-epidemic of TB Diabetes: A Call to Action” was launched to highlight a serious public health threat. This report promotes an international policy framework for action and lays out a research agenda to fill knowledge gaps on the topic of the co-epidemic of TB-diabetes. The purpose of the report is to highlight to various stakeholders like country policymakers, government officials, health care managers, clinicians, patients and patient groups and activists about the serious public health risk that is present between tuberculosis (TB) and diabetes.

It calls to action to address the threat of a double epidemic before it takes a larger toll in death and disability. Knowledge gaps that drive a research agenda have been identified and evaluation to measure progress and shape policy have been identified in this report.

Although diabetes was seen as a disease of the rich in the past, it is clear today that the disease is also prevalent in low- and middle-income countries, affecting the rich and the poor alike. Like HIV infection and malnutrition that compromise a person’s immunity, chronic conditions like diabetes, have also shown to impair a person’s defense system against TB. While diabetes has for long been focused as one of the non-communicable chronic diseases, this disease seems to quietly augment the spread of TB.

According to the IDF Diabetes atlas, while 382 million people were affected with diabetes in 2013, this number is projected to increase to about 592 million in the year 2035. One and a half million have said to have died due to tuberculosis in the year 2013 (Global Tuberculosis Report 2014). Patients with diabetes are three times more likely to get active TB. There is much evidence of high rates of diabetes in people with TB and of a significant number of diabetics being diagnosed with TB. India, already a high TB-burden country (WHO), also has an increasing number of people with diabetes - about 61.3 million adults in 2011 (IDF, Diabetes Atlas).

The report presents three broad challenges for responding to TB-Diabetes. These include:
(1) Providing regular bi-directional screening for the two diseases
(2) Administering quality-assured treatment to patients suffering from both diseases and
(3) Preventing TB in people with diabetes. 

While it stresses on TB-Diabetes, it also reminds us how TB and HIV had a similar presentation only a few decades ago. The reaction to that link though was very slow such that first reports about the associations were published in the 1980s, health warnings of a dual epidemic sounded in the early 1990s, and the first global “interim” strategy to address the issue brought out in 2004 – over 20 years later. Through this report, The International Union Against Tuberculosis and Lung Disease (The Union) and the World Diabetes Foundation, stress that we must not let history repeat itself – we must not delay steps required in controlling the dual epidemic and preventable deaths.

TB and Diabetes is managed under two separate national programs and this is true for India as well. While tuberculosis is under the care of the Revised National Tuberculosis Control Program (RNTCP), Diabetes is comes under the umbrella of top non-communicable diseases in the National Program on prevention of Cancer, Diabetes, Cardiovascular diseases and Stroke (NPCDCS). While NPCDCS is expanding calling for increased screening of diabetes in hospitals including many private ones, it is yet to be seen whether they will agree to screen referred patients with TB, given that very few private hospitals have facilities for the non-profitable treatment of TB patients. The India Tuberculosis-Diabetes Study group demonstrates, in their report, the feasibility for health centers in India to carry out screening, diagnosis and treatment for patients with TB and diabetes, it acknowledges that it is the methods in screening, via the questions asked and the diagnostics used, that will dictate the number of patients who are actually diagnosed and how cost-effective this process will then be.

The Looming Co-epidemic of TB Diabetes: A Call to Action emphasizes that it is imperative that strategies that improve health care access, diagnosis, treatment, prevention and financial risk protection must be embedded into policies for people suffering from TB and Diabetes. Stakeholders like political leaders, policy-makers, civil society groups  and patients’ organisations need to be part of this collaborative effort towards the damage that the co-epidemic can cause.

Looking forward
The report draws attention to a research agenda in TB-diabetes that includes screening and diagnosis, treatment, case management, disease surveillance, response, as well as monitoring and evaluation. It further recommends policymakers to establish policies that enable coordination between public health programs involved in controlling TB and diabetes, with a high priority in high TB burden countries. It stresses the importance of funding that needs to be made available to implement the research agenda. In implementing the program, it recommends assessing implementation costs and conducting pilot projects for dual screening if current implementation isn’t feasible. It also calls for sharing of plans with bordering countries so that patients who travel across borders have a “continuum of care”.

Further recommendations ask for financing bodies to make resources available and known to applicants along with the development of core competencies by technical assistance agencies. It encourages relevant clinicians to familiarize themselves with the screening protocols and in turn educate patients about risks involved. Advocacy in low- and middle-income countries with a growing challenge of TB-diabetes through campaigns is encouraged to educate policymakers, public health program implementers and international development agency leaders.

For India, this report with its research agenda and recommendations means increased collaboration, a steep increase in funding along with an increased commitment towards preventing the already dim situation from becoming any dimmer. How much further will the respective national public health programs take these suggestions? Only time will tell.

Carolyn Kavita Tauro, Citizen News Service - CNS
30 October 2014

No comments:

Post a Comment