Tuberculosis and Diabetes -Lessons From The Past

Alice Tembe, CNS Correspondent, Swaziland
As the world mobilizes for the world’s largest global conference on lung health issues in Barcelona –the 45th Union World Conference on Lung Health organized by The International Union against Tuberculosis and Lung Disease (The Union) from October 28 through November 1, 2014, it is essential to learn from our past as new research evidence surfaces. Since the advent of HIV in the 1980s and 1990s, TB was seen as a number one opportunistic infection accounting for the highest number of deaths among people living with HIV (PLHIV) in Swaziland, noted by the then Executive Director of the National Emergency Response Council on HIV-AIDS, Dr Von Vissel.

Today TB is emanating as an opportunistic infection among people with uncontrolled diabetes. 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. If left unchecked, 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.

As a lesson from our past experience with HIV-AIDS, it is essential, at the very beginning of the impending TB and diabetes threat, to engage the community in rigorous education and learning from sustainable and practical solutions to establish a formidable response to the threat. It is encouraging that the upcoming conference theme is "Community-driven solutions for the next generation". This theme reflects the need to find solutions to the lung health challenges we face by involving all stakeholders from health care professionals and policy-makers to the people and communities we serve. It is also very timely that after revewing the science on TB and diabetes, the Union and the World Diabetes Federation will be releasing the first policy report on diabetes-TB at the conference.

In rural Swazi communities where the major concern is where the next meal is coming from and having a roof over one’s head, there is a large sized population living with diabetes but having no knowledge of it. As noted by a machinist at a Textile and apparel company who lives in peri-urban Matsapha, the industrial town of Swaziland, Ncamsile Motsa (name changed), ‘We live far away from healthcare facilities, work long hours and do not have time or money to go to hospital for every little thing I feel. Actually I would not go to hospital if I am feeling fine and I can still perform my duties”.

Ncamsile is one of over 15000 young women and men working and living in the textile and apparel industry, for whom screening for diabetes is a luxury. Most of these community members find out that they have diabetes by chance, when a mobile outreach campaign is at their doorstep at work or where they live. Ncamsile also discovered that she had diabetes during a workplace wellness campaign.

According to WHO factsheet, diabetes is a chronic, lifelong condition that affects the body's ability to regulate its blood sugar content. There are three major types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes. All of these have something in common-- either the body does not make enough insulin; or it cannot use the insulin it produces, or a combination of both. It is possible to reduce the risk of developing diabetes through: maintaining healthy diet (that includes vegetables and fruits and reduces sugar intake); regular medical check-ups for blood sugar; being physically active and this does not mean to have a gym membership-- it can be just taking a walk or doing physical work in the garden and hence maintain a healthy body weight. However, if already on treatment in addition it is essential to adhere to medication even when feeling and to have in store a sufficient supply of drugs.

In recent a community education dialogue at a rural community in Swaziland, some unconventional medicine storage ideas that work were proposed by some patients, including keeping the drugs inside deep clay pots, inside the clothing cases, away from the windows and sunshine and away from the cooking space. This is an example of how programmes that develop standards for medication storage to include a refrigerator are irrelevant for rural communities who do not have access to refrigerators but have other skill sets that are usually not scientifically tested but work locally.

Dr Anthony D Harries, a Senior Advisor at the International Union against Tuberculosis and Lung Disease (The Union) expressed that there is no good evidence yet that INH prophylaxis is effective in reducing the risk of TB in people living with diabetes. It is critical to try and prevent people getting diabetes through good lifestyles and have people with diabetes ensure they have good diabetes control.

It is therefore, important to remember that:
  • Diabetes can be inherited, develop later in life and can be as a result of other body changes like pregnancy
  • Take every opportunity to test your blood sugar to understand your body response.
  • If on treatment, it is important to adhere and be consistent with it and check blood sugar regularly to ensure medication is effective
  • Onset of type 2 diabetes can be prevented by managing food type and amount, body weight and having regular blood sugar checks
  • If left unchecked, diabetes can result in stroke, blindness, heart attack, kidney failure, end nerve damage, impotence, and birthing complications… so screen for diabetes regularly and reduce chances of developing TB.
José Luis Castro, Executive Director of The Union has rightly said that, “Whether the focus is on better ways to deliver medications or access health care, create policies to reach under-served populations or leverage resources, sustainable health solutions for both the present and future generations will only be reached through the full and committed participation of communities.”

Alice Tembe, Citizen News Service - CNS 
15 October 2014