Bi-Directional TB Diabetes Screening in India and China
This year, The International Union Against Tuberculosis and Lung Disease (the Union), the World Health Organization (WHO), and the World Diabetes Foundation—in association with the Indian government—conducted a pilot project to screen more than 8,000 TB patients for diabetes and more than 10,000 diabetes patients per quarter for TB. Diabetes test results from TB patients at 7 tertiary hospitals and more than 60 primary health care centers across India showed that 13 percent indicated high blood sugar levels demonstrating diabetes. Upon receipt of interim data from the project, India’s Revised National TB Control Programme made a national policy decision to test all TB patients for diabetes in the country in September 2012.
The global health organizations launched the bidirectional screening project due to growing concerns about the rise of diabetes in low- and middle-income countries, and the potential link between diabetes and TB. Research has demonstrated that diabetes increases by two to three times the risk of TB—and patients who suffer with both have an increased risk of dying during TB treatment and of having a recurrent bout of TB after their TB treatment is completed. According to Anthony D. Harries, director of research for the Union, “of the 366 million with diabetes today, more than 150 million live in India and China,” Harries adds that with such a large population, finding ways to manage the two diseases effectively is important.
Using the approach outlined in the WHO/Union’s Collaborative Framework for Care and Control of Tuberculosis and Diabetes published in 2011, China was the first participant to implement bidirectional screening within the regular health care system. With assistance from the Union, the WHO, and the World Diabetes Foundation, China formulated a plan to conduct screenings in 11 health care facilities. Upon completion of this project in May 2012, there was agreement that the project should be expanded to further facilities across the country.
Harries noted that there were 8.7 million new cases of TB in 2011—and with an increase in diabetes cases, which are projected to reach 552 million by 2030—there will be implications for TB control, due to the link between the two diseases.
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