Tackling the Challenges of TB-Diabetes co-infection

Eranga Isaac, CNS Correspondent, Nigeria
TB is an infectious disease caused by the Mycobacterium TB. While it typically affects the lungs, it can affect virtually any part of the body. TB spreads from person to person through the air when someone sick with the disease coughs, sneezes or spits. Another person needs only to inhale a few of these germs in order to become infected. Key symptoms include cough, fever, night sweats, and weight loss, which can sometimes occur over many months.

About one third of the world’s population carries a latent TB infection. Typically, each person infected with TB has a 10% chance of progressing to TB disease within his or her lifetime. People with compromised immune systems—often caused by HIV, malnutrition, age or diabetes—or those who use tobacco regularly, have a much higher risk of developing TB disease. While TB is treatable and curable in most cases, without proper treatment up to two thirds of people with TB will die. TB is treated with a cocktail of multiple antibiotics taken  over  the  course  of  at  least  six  months, though multidrug-resistant cases require treatment for up to two years.

The 6th Edition of the Diabetes Atlas defines Diabetes as a chronic, non-communicable disease (NCD) that, if left unmanaged, can lead to a number of other serious health conditions. Diabetes occurs when the body either cannot produce enough of the hormone insulin, or it is not able to use insulin effectively. Insulin allows the body’s cells to absorb glucose and use it as an energy source.

There are three main types of diabetes: type 1, type 2, and gestational diabetes.Type 2 diabetes, a condition where the body does not use insulin properly, results in elevated levels of glucose in the bloodstream. It is a lifelong chronic condition and the most common form of the disease. Type 2 diabetes is almost exclusively the type that interacts with TB in the body. Statistics show that about 30% of deaths recorded in Nigeria are caused by TB together with HIV infections among the poor population in the country. A Public Health expert from the University of Ilorin Teaching Hospital, Dr. Busayo Agbana while delivering a paper titled Poverty, Illiteracy and Tuberculosis, at a seminar in Ilorin noted that Nigeria ranks 4th among 22 countries in the world with the highest burden of TB and 1st in Africa, with estimated cases of 283,100,000 people doubly infected with TB and HIV. He said that currently Nigeria records 120,000 new case of TB yearly. Dr. Agbana explained that even with government establishment of the TB and Leprosy control system, there are still cases of transmission through direct infection.

He noted that another cause of transmission is through over crowded environments that are susceptible hosts of the disease, adding that the disease is curable and could be reduced through the use of anti- TB drugs. Many have expressed concern that Nigeria’s high TB burden can be attributed to over-crowding and poor sanitation.

According to Prof. Oni Idigbe, former Director General of the Nigerian Institute of Medical Research (NIMER), no fewer than 12 persons in a small community contract TB each time one infected person coughs or sneezes the bacteria causing agent.This process continues multiplying as each persons infect other newer 12 persons within a community continuously. TB is still a myth in many rural and urban parts of the country. “Nigeria is also contending with over 2,700 cases of multi-drug-resistant TB (MDR-TB), yearly”, Idigbe added.

Dr Tunji Funsho, Rotary’s National PolioPlus Chair for Nigeria, said that recent intensive efforts to improve collection and reporting of data on TB are shedding new light on the epidemic, revealing that there are almost half a million more cases of the disease than previously estimated. One of the most important developments in TB globally is that it is increasingly working with diabetes. Diabetes weakens people’s immune system, tripling a person’s risk of getting TB. Diabetes is escalating globally—and especially in countries where it is common for people to be carrying a latent TB infection. The increase in diabetes is going to drive the spread of TB—much the same way that HIV/AIDS started driving the spread of TB in the 1980s and 1990s. Diabetes is rampant in low- and middle-income countries, affecting the poor and rich alike, and increasing the risk of TB across all population segments.

According to Dr Anne Detjen, a Consultant with the Union: “There are linkages between TB and diabetes (people with diabetes are at increased risk for TB) and certain, especially chronic, lung diseases can have an effect on the heart”. A new report- The Looming Co-epidemics of TB-Diabetes: a call to Action published by the International Union Against Tuberculosis and Lung Disease (the Union), and the World Diabetes Foundation, warns that: “The growing burden of TB-diabetes is changing the landscape of TB care and prevention. Increasing prevalence of non-communicable diseases and aging populations are increasing the relative importance of different risk factors for TB. While classical TB risk factors and co morbidities—like undernutrition and HIV-infection—remain crucial to address, chronic conditions that impair people’s defense against TB, such as diabetes, have emerged as additional important factors”.

The world faces a looming co-epidemic of TB-diabetes, and this is a serious public health risk we need to urgently address. If we fail to act, the consequences could prove catastrophic for healthcare systems in areas that are impacted.

Eranga Isaac, Citizen News Service - CNS
29 October 2014