Diabetes and tuberculosis: Partners in crime?

Chhatra Karki, CNS Correspondent, Nepal
Diabetes is now no longer constrained to the domain of riches and upper class only. Recent trends reveal that both the regal and the plebeian are joining the club of those living with diabetes. Diabetes is gaining its foothold especially in the countries with low and medium Per Capita Income (PCI). Diabetes was for a long time treated as non-communicable disease (NCD) but now the experts opine that diabetes is now turning out to be a 'launch pad' for a disease usually not classified as a NCD: Tuberculosis (TB).

People with diabetes are three times more susceptible to contracting TB than those without diabetes. International Diabetes Federation (IDF)'s Diabetes Atlas reveals a serious scenario—World is yielding to diabetes in an accelerated rate. Statistics predicts that the population of people with diabetes which was 382 million in 2013 will hit 592 million in 2035. The TB-diabetes co-morbidity is slowly but steadily taking the form of an epidemic. Instantaneous measures to control this trend is crucial. Most importantly since the diseases/ conditions are joining hands, it is important for disease-control programmes to join hands as well: TB and diabetes care and control programmes need to collaborate amongst themselves optimally to address this dual pandemic.

Global Tuberculosis Report 2014 reveals about 1.5 million deaths due to TB in 2013.

The studies conducted in various countries show the high probability of TB infection in the patients with diabetes. Experts agree on the dreadful epidemic situation it can lead to if the TB-diabetes co-morbidity is not checked in time. The old maxim 'prevention is better than cure' should be given due attention without delay.

The scenario in 22 high TB burden countries has worsened and the number of cases with diabetes-TB co-morbidity has increased during the last three years. India and China together accounts for over 40% of the total cases of the double burden of diabetes-TB. Surprisingly, there is no classified testing centre in Nepal to deal with the cases of diabetes-TB co-morbidity, which makes it difficult to treat the patients. According to National Tuberculosis centre, 40,000 people get TB every year, 20,000 new sputum positive cases and 5000-7000 people die each year from TB in Nepal alone.

A report entitled "The Looming Co-epidemic of TB-Diabetes: A Call to Action" was released at the 45th Union World Conference on Lung Health in Barcelona, Spain. This report aims to inform the policymakers, government authorities, leaders, hospitals, and patients regarding this serious public health issue of TB-diabetes co-morbidity.

The report also focuses on the need for regular bi-directional screening of TB and diabetes among other policy recommendations. Senior physician at Bir Hospital in Nepal, Dr Bhupendra Kumar Basnet, says, "Such patients should be attended with care, and provided evidence-based diagnostics and quality standard treatment. Effective measures should be adopted without any delay to prevent people with diabetes from contracting TB." Despite overwhelming evidence from the communities, government programmes took years to join forces and come up with collaborative TB and HIV activities - this delay is not counted in days, weeks, months or years, but is counted in number of new TB infections among people living with HIV and deaths owing to the co-infection. We should not delay implementing and scaling up TB and diabetes co-morbidity programming at all levels. "We saw something similar happen with TB and HIV years ago, now similar deadly synergy is visible between TB and diabetes,” said Dr Anthony Harries, Senior Advisor to International Union Against Tuberculosis and Lung Disease (The Union). “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."

Chhatra Karki, Citizen News Service - CNS
13 November 2014

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