Addressing diabetes is vital for strengthening tuberculosis control

By Amit Dwivedi
December 11, 2008
The author is a Special Correspondent, Citizen News Service (CNS). Email: amit@citizen-news.org, website: www.citizen-news.org

Patients with type-2 diabetes may be at increased risk of contracting tuberculosis (TB) because they generally have a compromised immune system, which results in life-threatening lung infections that are more difficult to treat.

Research at the University of Texas School of Public Health Brownsville shows that type 2 diabetes, especially when it involves chronic high blood sugar, is associated with altered immune response to TB. Patients with diabetes and TB take longer to respond to anti-TB treatment, and that patients with active tuberculosis and type-2 diabetes are more likely to have multi-drug resistant TB (MDR-TB). Almost six percent of people with diabetes had MDR-TB, reported this study. 30 per cent of those with MDR-TB also had type 2 diabetes.

According to World Diabetes Foundation (WDF), it was estimated that in 2007 there were 246 million people living with diabetes, 6 million new cases were diagnosed and 3.5 million people died due to diabetes.

According to the Global TB Control report, published by World Health Organization (WHO) for the same year, there were 14.4 million people living with TB, 9.2 million new cases and 1.7 million died due to this disease. While it is recognized that 95% per cent of TB patients live in developing world, it is not so well known that 70 per cent of people with diabetes also live in developing countries, especially in Southeast Asia and the pacific region.

India has a strong TB control programme in the world, referred to as the Revised National Tuberculosis Control Programme (RNTCP) or Directly Observed Treatment Shortcourse (DOTS). However, we need to focus more for its effective implementation. Public- private partnership can alleviate the problem of TB in people living with diabetes, said Dr Anthony D Harries, senior advisor, International Union Against Tuberculosis and Lung Disease (IUATLD, The Union).

Dr Harries was of the opinion that, "there are many risk factors for TB, which include HIV/AIDS, silicosis, malnutrition and smoking. While the link between TB and diabetes has been known since roman times, it is only recently that unequivocal evidence has been gathered to show a strong association between the two diseases. With an estimated 21 million adults with diabetes and 900000 incident pulmonary tuberculosis (PTB) cases in 2000, diabetes accounted for nearly 15% of pulmonary TB and 20% of smear- positive pulmonary TB. Diabetes therefore appears to increase the risk of active TB."

Dr Harries advocated that "there are three pronged approach for the DOTS strategy for TB control: 1) identify TB patients through passive case finding, 2) diagnose TB through sputum smear examination and 3) put the patients on anti-TB treatment."

Dr. Harries further said "In most of the developing countries there are no systematic ways of monitoring or evaluating patients with non-communicable diseases (NCD). This has to change. The DOTS framework for TB control, developed by the IUATLD and WHO, has allowed structured, well-monitored services to be delivered to millions of TB patients in some of the poorest countries of the world. In a resource poor-country like Malawi , the DOTS model was successfully adapted for scaling up and monitoring antiretroviral therapy (ART) to people living with HIV (PLHIV). This model can be adapted for NCDs, such as diabetes, as well. With treatment cards and registers, it would be feasible to make comprehensive quarterly reports on diabetes treatment outcomes, which would include the monitoring and evaluation of co-morbidities such as TB."

The Millennium Development Goal number 6, specifies that the incidence of infectious diseases such as TB should be halted and reversed by 2015. To succeed in achieving this target, it is important to focus on resource-poor countries not only on for HIV/AIDS but also on the burgeoning epidemic of diabetes as a significant epidemiological risk factor.