Health programmes must collaboratively address TB–diabetes
With growing strong evidence on the dangerous communion
between tuberculosis (TB) and diabetes in India, government
health programmes must no longer delay implementing
TB-diabetes collaborative activities. “Like the HIV/AIDS
epidemic, the diabetes epidemic threatens to cause an
escalation in TB incidence. China and India constitute 40% of
the world’s diabetes population of 400 million people
which is likely to go up to half a billion by 2020. If we do
not seriously think about the link between TB diabetes my
feeling is that it may begin to derail some of the good
advances made in India and China on TB control” said
Professor (Dr) Anthony D Harries, Senior Advisor, International Union Against Tuberculosis and Lung
Disease (The Union).
"In 2011 India had 6.13 crore people living with diabetes with
983,000 deaths attributable to the disease. India also
accounts for 21% of the global incidence of tuberculosis (TB)
with 19.8 lakh people developing TB and nearly 300,000 dying
of it every year" said Shobha Shukla, Director, CNS Diabetes
Media Initiative (DMI) and former senior faculty, Loreto
Convent College.
Diabetes Mellitus is a non-curable, non-communicable metabolic disease that occurs when either the pancreas fail to produce sufficient insulin, (the hormone that regulates blood sugar), or when the body cannot use the insulin it produces effectively. It can be treated and controlled effectively although, over a period of time, it does increase the risk of heart disease and stroke and can cause kidney failure, blindness and nerve damage. TB, on the other hand, is a curable airborne disease caused by the Mycobacterium TB that spreads from one person to another through airborne particles.
TB-DIABETES - The Dangerous Communion
Diabetes has a proven relationship with TB. Studies have shown
that
diabetes triples the risk of contracting TB
(risk of developing active TB disease goes up to
five times if person has diabetes and also
smokes) and can worsen the
course of TB. TB in its turn can
worsen glycaemic control in people with
diabetes. Research has also shown that people with diabetes
respond to anti-tuberculosis treatment at a much slower rate.
People with a weak immune system, due to chronic diseases such
as diabetes, are at a higher risk of progressing from latent to
active TB. Diabetes too is complicated by the presence of
infectious diseases, including TB.
Professor (Dr) Surya Kant, Head of the
Pulmonary Medicine Department, King George’s Medical
University (KGMU), said that 3-4% of his TB patients are found
with hitherto undiagnosed diabetes. He cautions that,
“Ideally before starting Anti TB Treatment (ATT) in
patients having diabetes, they should be put on injectable
insulin therapy for smooth control of blood sugar levels. Once
the treatment is successfully completed, they can switch back to
oral therapy. Also, doctors must rule out diabetes in all
pulmonary TB patients over 40 years of age who have symptoms
like significant weight loss, increased appetite, and increased
thirst. Similarly, any person who does not respond to ATT within
2 to 4 weeks should be tested for diabetes.”
Diabetes can be treated and managed, but, over time, it
increases the risk of heart disease and stroke and can cause
kidney failure, blindness and nerve damage. In 2011, there were
an estimated 4.6 million diabetes-related deaths, 80% of them in
low- and middle-income countries. This number is expected to
double by 2030. The World Health Organization and The Union have
published in August 2011 a provisional framework to guide
national programmes on how to establish a coordinated response
to both diseases at organisational and clinical levels. Also,
last year The Union and its partners in China carried out a
9-month first bi-directional screening initiative, screening TB
patients for diabetes and diabetes patients for TB in a few
hospitals.
Informs Dr S Srinath, Senior Operations
Research Fellow,
The Union's South East Asia Regional Office, in Delhi: "In India, we are
testing one of the components of the WHO and The Union's 'Collaborative Framework on the Care and Control of
Tuberculosis and Diabetes' called bi-directional screening, review meeting of which is
later this month."
Diabetes and TB represent a critical intersection between
communicable and non-communicable diseases. The link between
these two diseases may become even more meaningful in coming
years, as the prevalence of obesity and diabetes are expected to
rise dramatically in the resource-poor areas where TB thrives.
With growing evidence, government of India must consider
implementing a rational and evidence-based TB and diabetes
collaborative programme.
CNS
http://www.citizen-news.org/2012/10/health-programmes-must-collaboratively.html
