Diabetes And TB: Double Trouble

Chhatra Karki, CNS Correspondent, Nepal
TB has established its strong foothold as an epidemic, especially in the low and middle income countries, and diabetes is adding fuel to the fire. World Health Organization (WHO)  identifies about 8.6 million cases of TB annually. At the same time, around 382 million people in the world live with diabetes. This cannot be good!

The ‘hybrid’ of diabetes and TB is hampering the TB control measures in practice. Various researches bring forth the dark correlation between these two diseases. Comprehensively, more people with diabetes are found in countries which already have high rates of TB cases. In this context, experts have been advocating the necessity of effective policies in place regarding the assessment of diabetes in TB patients. Dr. Bhupendra Kumar Basnet, Senior Physician at Bir Hospital Kathmandu, Nepal opines that in the absence of classified testing centres for simultaneous examination of TB and diabetes, patients are forced to bear the inconvenience during the checkup and it becomes difficult to confirm the co-infection of TB and diabetes in them. When TB and diabetes co-exist, the subsequent treatment of diabetes without TB diagnosis is nothing more than a waste of time and resources.

Dr Anthony Harries, Senior Advisor and Director, Department of Research, at the International Union against Tuberculosis and Lung Disease (The Union) says, “Diabetes, for reasons that are not entirely clear, damages the immune system by interfering with how the white cells in the body respond to infections. The white cells that keep the TB bacteria under check do not work as well as they should. About 2 billion people in the world have TB bacteria in their bodies, and in the majority of cases they never get the disease because these bacteria are kept under control. However, if a person gets diabetes, the TB bacteria are not kept in check and they can then cause the disease. There is evidence to suggest that those whose diabetes is out of control are at higher risk of developing TB.”

The scenario in 22 high TB burden countries has worsened and the  number of cases with diabetes-TB co-infection has increased from 10% to 15% 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-infection, which makes it difficult to treat the patients.

Diabetes degrades the immune system of the person, making him/her more susceptible to TB-- numerically speaking, the chance of contracting TB increases by more than thrice in them as compared to the normal cases. This calls for a quick medical checkup when a person with diabetes shows protracted signs of coughing, fever, and loss of appetite—which may be indications of TB. Doctors strongly urge the patients to keep in check their diabetes first and then proceed with TB diagnosis when the maladies co-exist. According to Dr. Harries,  If a person has diabetes the best way to prevent TB is to ensure that the diabetes and hence the blood glucose levels are kept as well controlled as possible.

A good initiating point would be the establishment of cooperation among Nepal Government, Ministry of Health, Health Service Department, and National Tuberculosis Centre. It is also necessary to increase the awareness in the public regarding the diabetes-TB co-infection. While about 3 million TB patients are lost to the National TB programmes globally, nearly half of those living with diabetes are not aware of their diabetes status. The medical treatment of TB would be remarkably improved in people with diabetes co-infection if their glucose levels are kept under control.

The Union and the World Diabetes Federation are going to release a policy report on ‘Diabetes-TB’ co-infection based on their study of the inter relationship between the two diseases at the 45th Union World Conference on Lung Health which will take place in Barcelona, Spain. This policy report is expected to address some important issues pertaining to this dangerous synergy between a bacterial and non communicable disease.

Chhatra Karki, Citizen News Service - CNS 
16 October 2014