Addressing diabetes is vital for strengthening tuberculosis control

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 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. “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.”