The Dangerous Communion of Tuberculosis and Diabetes
With its high rates of diabetes and tuberculosis, India faces challenges in controlling both diseases. In India in 2011, there were 61.3 million people living with diabetes, and 983,000 deaths from the disease. India also has 1.98 million people developing TB and almost 300,000 people dying of it each year. Patients with diabetes are at greater risk of contracting TB, and diabetes can worsen the course of TB. TB can worsen glycaemic control in patients with diabetes. To address these diseases, strategies are needed to manage patients with both diseases and cross-screen patients with each disease.
According to Professor (Dr.) Anthony Harries of the International Union Against Tuberculosis and Lung Disease (The Union), “Diabetes upsets the immune system in different ways and if the immune system is down, the risk of contracting TB as well as other infections increases. So in patients with diabetes, we need to think about TB and screen them, and in patients with TB, we need to think about diabetes. If we do not seriously think about the link between TB [and] diabetes, it may begin to derail some of the good advances made in TB control, especially in countries like China and India.”
The increasing incidence of diabetes, especially in low- and middle-income countries, is threatening to have a negative impact on TB control, and vice versa. To address these two diseases and their impact on each other, the World Health Assembly set the target “25 by 25” at its May 2012 meeting. The goal is to reduce deaths from preventable non-communicable diseases (NCDs), such as diabetes, by 25 percent by 2025.
The World Health Assembly and The Union published a Collaborative Framework on the Care and Control of Tuberculosis and Diabetes in 2011 that guides national programs, clinicians, and others engaged in the care of patients and prevention and control of diabetes and TB on how to establish a coordinated response to both diseases at organizational and clinical levels. The Union and its China partners conducted an initiative in a few hospitals in China to increase screening of TB patients for diabetes and diabetes patients for TB. A similar initiative is being conducted in India.
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