TB & Diabetes: How will I live?

Alice Tembe, CNS Correspondent, Swaziland
It seemed like the sun will not set, as Thandiwe Tsabedze (name changed), a 38 year old mother sat by the doorstep of her home in Msunduza while her children played with laughter in the backyard. Thandiwe had developed diabetes as a side effect of antiretroviral treatment  (ART) that she started on a few years ago. At that time she was also diagnosed, and was successfully treated, TB as well.

Today, as I interview Thandiwe, she is in her fifth month on treatment for recurrent TB and the symptoms have not subsided. So she is being investigated for multi drug resistant TB (MDR-TB). As I explain the correlation of TB and diabetes to Thandiwe, the light in her eyes fade. She seems to be convinced that this time she will not outlive the TB-diabetes threat. In many cases, diabetes is the last query for patients with TB, yet evidence is increasingly proving that where TB in diabetes may linger, and vice versa.

According to Dr. K S Sachdeva, Additional Deputy Director General (TB), Central TB Division, Ministry of Health and Family Welfare, India, studies have shown that TB patients with poorly managed diabetes have poor TB treatment outcomes. While there are multiple factors that could have resulted in the recurrence of TB in Thandiwe, like the immune-suppressant HIV, exposure to other active TB patients and poor nutrition, it is also true that poor diabetes management could have played a major role.

It therefore suffices to be in agreement with remarks presented by Paul Jensen, a Senior Advisor-Policy, at the International Union Against Tuberculosis and Lung Disease (The Union), on ‘Can we avert the Looming TB-Diabetes Co-epidemic?’

He explained that it is known through evidence now that:
  • Diabetes increases the risk of developing TB by 2-3 times
  • Diabetes is escalating around the world
  • Approximately 387million people are affected by diabetes today with 4 out of 5 of them living in low and middle income countries where TB is also prevalent
  • It is projected that worldwide 592 million people will be affected by diabetes by 2035
These critical findings indicate the need for major investments of time and effort, as welll as financial and human resources to avert this threatening TB-diabetes co-epidemic. Effective management for co-morbidity of TB-HIV had been developed after witnessing the high cost (in terms of lives lost and economic disempowerment) of the silo-approach to management of these correlated threats. In the case of diabetes and TB, the world need not wait to witness multiple deaths before efforts are forged to avert this impending global epidemic. The escalation of diabetes around the world will overly reverse and impede the efforts to control TB, noted Paul Jensen.

Embracing a coordinated response will enable the many Thandiwes around the world to be able to look into the future with hope.

Alice Tembe, Citizen News Service - CNS
November 15, 2015