Tuberculosis (TB) continues to be a major global public health challenge with nearly 9 million new cases and 1.5 million deaths due to this disease annually. There are several identified risk factors for TB including HIV, smoking, under nutrition, occupational lung diseases (like silicosis) and several others. One of the fast emerging risk factors for TB, which most people remain unaware of, is Diabetes Mellitus (DM). Recent research findings confirm that diabetes by itself triples the risk of developing TB and adversely affects disease presentation and treatment outcomes. Prevalence of diabetes is estimated to increase exponentially from 382 million cases in 2013 to 592 million cases by 2035. It is likely that diabetes will soon surpass HIV as the most important risk factor for TB. Most importantly the burden of diabetes is moving from developed to developing countries which unfortunately also carry high burden of TB.
Of the 10 most diabetes-affected countries globally, six (China, India, Brazil, Indonesia, Pakistan and the Russian Federation) are also high-TB-burden countries. In India, with 2 million TB cases (24% of the global TB burden and an estimated 60 million diabetes cases) the environment is perfect to jeopardise the gains. All of these countries have large number of people suffering from active tuberculosis, and even greater numbers are infected with TB. If TB-DM control measures are not implemented in timely manner, these countries may witness looming co-epidemics of TB-DM, which in turn, will compromise the gains of the TB control efforts done so far. The key to success in controlling this menace is to halt the progression of DM while strengthening screening of TB patients for DM and diabetes patients for TB.
Diabetes, which was considered a disease of the affluent and generally seen in economically developed countries, has started to impact deprived populations and is spreading like fire in the underdeveloped and developing countries. The general belief of TB affecting the marginalised class and diabetic to the wealthy class is proven to be wrong. The rampant spread of diabetes among both poor and rich classes in the developing countries has increased the risk of TB across all segments of population.
The mounting encumbrance of diabetes is shifting the scenery of TB care, prevention and control. A strategy to enhance accessibility to affordable health care, diagnosis, clinical care and management—measures to prevent and protect the diseases in masses—needs to be fairly adopted. A coordinated effort for planning and implementation across communicable and non-communicable national public health programmes is a pre-requisite. The essential approaches are succinctly outlined in the Tuberculosis and Diabetes collaborative framework developed by WHO and the Union in 2011, which outlines three areas to focus on: first, providing regular bidirectional screening for the two diseases; second, administering quality-assured treatment to patients suffering from both the diseases; and finally, preventing TB in people with diabetes. The world has witnessed how HIV caused TB to skyrocket in sub-Saharan and Asian countries in 1990s. The realisation of the potential impact of the TB-HIV co-epidemic and the response to it was slow, leading to enormous and avoidable loss of life plus economic cost. Such blunders can be evaded in case of the looming TB-Diabetes co-epidemic. A broad consensus within government, civil society and public health agencies needs to be build up at the earliest to make everybody understand the severity of the problem and its serious negative impact on the TB control program in the country, so that its most detrimental consequence can be checked before it shapes up as co-epidemics.
Source: Global Health Now