Health experts have called for international action against a looming co-epidemic of diabetes and tuberculosis, in a new report published on 29 October.
The International Union Against Tuberculosis and Lung Disease (the Union) and the World Diabetes Foundation released the report at the opening of the 45th Union World Conference on Lung Health in Barcelona, Spain. Among other evidence, it draws on lessons learned from the response to TB-HIV co-infection.
The report is the first to present the epidemiological evidence and a framework for the response. It recommends that healthcare systems begin offering bi-directional screening, where people with TB are screened for diabetes and people with diabetes are screened for TB, then offered appropriate treatment services.
Diabetes increases TB risk
Tuberculosis is an airborne, infectious disease caused by bacteria while diabetes is a chronic illness that weakens the immune system. Diabetes triples the risk that a person will develop TB. It is skyrocketing globally, projected to increase from 382 million cases in 2013 to 592 million cases in 2035.
Unless steps are taken to halt the trend, the consequences will be an increasing number of people who develop TB as a result of diabetes, potentially reversing the progress made against TB over the last few decades.
Dr Anil Kapur, member of the board of directors of the World Diabetes Foundation, said: “Ice hockey legend Wayne Gretzky was successful due to his playing strategy. His objectives was not to skate to where the puck was on the ice, but always to skate to where the puck was heading. We need to use the same approach to TB-diabetes.”
Lessons from TB-HIV response
Dr Anthony Harries, senior advisor to the Union, said: “We saw something similar happen with TB and HIV and AIDS to what is happening now with TB and diabetes. For years we had medical evidence that the two diseases were working together, as HIV destroyed people’s immune systems, allowing TB to quadruple in many countries in Africa. And for years we had a policy framework for responding.
“But it took years to mobilise a robust response, and millions of people were impacted by TB-HIV co-infection before it became the norm to screen people living with HIV for TB and vice versa. We want to raise an alarm that we don’t watch history repeat itself with TB-diabetes.”
Dr Kapur added: “In places where this issue has been studied, from India to China to East Africa and the United States, we’re seeing significantly higher rates of diabetes among TB patients than what appears in the general population. If we don’t act now to head this off, we’re going to experience a co-epidemic of TB-diabetes that will impact millions.”
Involving communities
Six of the ten countries projected to have the greatest numbers of people living with diabetes by 2035 – China, India, Brazil, Indonesia, Pakistan and the Russian Federation – are classified as high TB burden countries by the World Health Organization (WHO).
The theme of the World Conference on Lung Health – Community-Driven Solutions for the Next Generation – was chosen to reflect the need to find solutions to lung health challenges by involving the people and communities affected, as well as health workers and policymakers.
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