TB-diabetes co-morbidity: A two headed monster

Dr Richa Sharma, CNS Correspondent, India
Photo credit: CNS: citizen-news.org
The ever-increasing figures of people affected individually with TB or diabetes have been giving nightmares to health care professionals all over the world. So one can imagine the stupefying scenario when these two diseases start appearing together as co-infections. It is likely that diabetes may soon surpass HIV as the most important risk factor for TB, if the looming co-epidemic of TB and diabetes is not dealt with properly.

Paul Jensen, a Senior Advisor (Policy) at the International Union Against Tuberculosis and Lung Disease (The Union) elaborated on this crucial issue during a webinar hosted by Citizen News Service (CNS) stating that, “TB-diabetes is an example of a public health challenge that will become more serious unless action is taken now to prevent it. This is relevant for the post-2015 sustainable development goals, because the goals aim to end the TB epidemic by 2030. But the TB epidemic will not be eliminated in the absence to a response to TB-diabetes.”

Diabetes, a chronic metabolic disorder, triples the risk of developing TB among its patients. It weakens the immune system and makes the individual more susceptible to contracting the infectious disease. The world is witnessing an increasing proportion of diabetes cases in the developing world, busting the long-believed myth of it being a rich man’s disease. It is projected that by 2035, a total of 592 million people will be affected by diabetes and 80% of them will be from low- and middle-income countries. At the same time, TB affected 9 million people and took 1.5 million lives in 2013.

Jensen highlighted that an estimated 15% of all people with TB worldwide also have diabetes. This comes out to be 1,042,000 adults who have TB and who are also living with diabetes. This is only slightly less than the number of people with TB who are living with HIV infection. 

As pointed out in an article co-authored by Dr Sarabjit Chaddha, Project Director at the Union, of the 10 countries worst affected by diabetes, 6 are also high TB burden settings (China India, Pakistan, Brazil, Indonesia and Russian Federation). India not only contributes to 24% of the global TB burden (2 million cases), it is also home to an estimated 60 million cases of diabetes cases. This makes the situation very grave, and unless it is addressed urgently, India faces the risk of compromising the gains of its TB control programme.

Both the diseases are fundamentally different in their nature (TB is communicable and diabetes is non-communicable), yet interact bi-directionally to hamper the health of the affected individuals. Diabetes negatively affects the clinical course of TB and may lead to unfavorable TB treatment outcomes, relapse and even death, whereas TB exacerbates poor glycaemic control in patients on diabetes medication.

Globally, healthcare professionals have been advocating the bi-directional screening for the diseases as an effective way to diagnose and treat these conditions at the earliest. This screening would entail screening TB patients for diabetes and vice versa.

A pilot project for bi-directional screening of TB and diabetes patients was conducted in India through collaboration between The Union, the World Health Organization (WHO), the World Diabetes Foundation (WDF) and the Government of India. 13% of the TB patients surveyed had high blood sugar levels, indicating diabetes. The survey data presented to India's Revised National TB Control Programme in September 2012 helped in envisaging a crucial policy decision at the national level to scale up testing of all TB patients for diabetes in the country.

WHO’s Collaborative Framework for care and control of TB and diabetes 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.

Jensen rightly remarked that, “In the post 2015 development scenario, addressing TB and diabetes in an integrated way will challenge health systems-partly because the conventional approach is for infectious diseases and chronic illnesses to be seen as two different types of health challenges. There is not much interaction between infectious disease experts and NCD experts at the national and international level. So part of the challenge will be to break down barriers and to open communication among different groups of public health experts”.

Dr. Richa Sharma, Citizen News Service - CNS
August 26, 2015