People unaware about TB-diabetes link

Zehru Nissa, Jammu and Kashmir
Photo credit: CNS: citizen-news
(First published in Greater Kashmir, India on August 3, 2015) 
Doctors have expressed concern at the low levels of awareness regarding the link between TB and diabetes in Kashmir and have demanded that more efforts should be put for better detection and management of diabetes in the state.

“The growing numbers of people living with diabetes in Kashmir coupled with the mounting evidence that people with diabetes are more susceptible to TB should ring alarm bells,” said Dr Naveed Nazir Shah, HoD Chest Medicine at Chest Diseases Hospital in Srinagar. He said that although diagnosis of most cases of TB was possible through India’s Revised National Tuberculosis Program (RNTCP), there is no such programme for detection of diabetes.“There is no state or national programme that would test people’s sugar levels. However, in case of TB, there is a fair amount of awareness about how cough for more than two weeks needs to be checked,” he said.

Doctors are also concerned about the lack of efforts on part of the Jammu & Kashmir Health and Medical Education department to spearhead health campaigns for better outcomes of TB treatment and diabetes control.

“Everyone is working in isolation here. There is no coordination between endocrinologists, physicians, public health analysts and researchers,” said a doctor. “Moreover,” he added, “What is our health policy? Is it based on our health realities?”

The World Health Organisation (WHO) recommends that all people with TB should be screened for diabetes. It also advocates screening for TB in people living with diabetes, especially in high-risk populations.

A physician said that, “These recommendations are more relevant in our setting as we still have a considerable load of TB, especially in some belts.” He added that researches have proved that people with diabetes, who are also infected with TB, have a higher risk of death during TB treatment and of TB relapse after treatment.

With RNTCP running into rough patches every now and then due to non-payment of salaries of employees of DOTS centres in Kashmir, these centres are also not able to deliver TB care and control, as a result of which the TB treatment regimen also suffers.

“What motivation will a DOTS provider have if his/her salary has not been paid for many months altogether? What obligation does he/she have to be there for the patient and dispense medicines?” a member of an association of RNTCP employees asked.

Doctors warn of the complications in diabetes due to the presence of infectious diseases, including TB. “Proper care for diabetes is imperative for people with TB,” Dr Shah said. Experts have warned about the consequences of lack of interaction between infectious disease experts and life-style disease experts in Jammu & Kashmir. “It is a challenge as how to have a smoother and better interaction; break down barriers and open communication among different groups of public health experts,” a public health expert said.

While the National Disease Control Programme gives a lot of impetus to TB care and control activities, diabetes is still considered a life-style disease with no governmental scheme or programme addressing it. Non-communicable diseases contribute to 39.1% of the national disease burden against the 24.4 % of the communicable diseases. So it becomes all the more important to have collaborative efforts, rather than work in silos, if the goal is to eliminate TB and control diabetes as part of the post 2015 development agenda.

(First published in The Greater Kashmir, India on August 3, 2015)

Zehru Nissa, Citizen News Service - CNS
August 19, 2015