Action against TB-Diabetes co-epidemic: If not now, then when?

Dr Richa Sharma, CNS Correspondent, India
Photo credit: CNS:
The world is threatened by yet another big looming co-epidemic of TB and diabetes. And no, it has not happened overnight-- it has taken its own time to evolve and emerge as a public health emergency. The situation is so very similar to the TB-HIV epidemic and the late response that was meted to it that it scares the policymakers, public health professionals and people across all strata of society to think about the impact that this combination of deadly diseases will have, once it strikes with full force.

There is abundant data available on the current status of TB and diabetes and public health bodies have been ringing the alarm bells for a long time now, urging governments to call for action and handle the impending doom.

India tops the list with the highest number of diabetes cases in the South-East Asia region (66.8 million cases) giving it the dubious distinction of being the diabetes capital of the world. To add fuel to this raging fire are the estimated 2.1 million TB patients in India. In a webinar hosted by CNS, Dr Sachdeva, Additional Deputy Director General, Central TB Division, Ministry of Health and Family Welfare, India, said that patients with diabetes have a three fold increased risk of developing TB, as compared to the general population. He also explained that India needs to be concerned about this co-epidemic as 13% of the TB patients in the country are co-infected with diabetes as well, and that is a huge number to tackle.

The global health professionals have been advocating bi-directional screening as a first line of action to identify the real burden of such cases. This screening would entail screening TB patients for diabetes and vice versa. The Collaborative Framework for Care and Control of TB and diabetes, formulated by the WHO and the International Union Against Tuberculosis and Lung Disease (The Union), outlines essential steps for coordinated action in three areas:
  • Establishment of mechanisms for collaboration between national TB programmes and suitable counterparts responsible for care and control of diabetes.
  • Improved detection and management of TB in patients with diabetes
  • Improved detection and management of diabetes in patients with TB
It thus urges, amongst other things, that countries establish mechanisms for collaboration and take policy decisions to formalize the system of bi-directional screening for TB and diabetes in order to diagnose and manage both the diseases.

Elaborating on the mechanism to address this, Dr. Sachdeva informed about the collaborative framework that has been developed in India by the Ministry of Health and Family Welfare, in consultation with various stakeholders. Sharing the results of feasibility pilot studies carried out in India, he said that bi-directional screening worked well through tertiary centres and TB units.  However, he clearly mentioned that more details need to be worked out in terms of human resource requirement and maintenance of electronic health records.

A historic declaration was recently signed in Bali, in Indonesia, to fight this issue at hand, by over 100 public health professionals and calling for action against this co-epidemic by advocating bi-directional screening as an active component of preventive strategy. Hopefully this will bring the much needed attention on this issue and enable the countries to robustly take up the fight against the co-epidemic.

Dr Richa Sharma, Citizen News Service - CNS
November 24, 2015

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