World Diabetes Day offers opportunity to raise awareness of link between diabetes and TB

The links between diabetes and unhealthy eating, obesity and lack of exercise are well known, but this World Diabetes Day (14 November), The Union and the World Diabetes Foundation are hoping to increase awareness of another dangerous link – between diabetes and tuberculosis.

Research has shown that diabetes triples the risk that a person will develop tuberculosis, and with diabetes skyrocketing globally, The Union and the World Diabetes Foundation have published a report, The Looming Co-epidemic of TB-Diabetes: A Call to Action.  The report is the first to present the epidemiological evidence and a framework for responding, with recommendations for policymakers. A major recommendation is for healthcare systems to 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.

The number of diabetes cases is projected to increase from 382 million cases in 2013 to 592 cases in 2035, with the burden of disease moving from developed countries into developing and emerging-market countries. Unless steps are taken to halt the trend, the consequence will be an increasing number of people who develop tuberculosis as a result of diabetes, potentially reversing the progress made against TB over the last few decades. An estimated 1.5 million people died of tuberculosis in 2013, according to the World Health Organization.

 "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,” said Dr Anil Kapur, member of the Board of Directors of the World Diabetes Foundation.  “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 and sap public health systems of precious resources. The key is to prevent this from happening.”

“We saw something similar happen with TB and HIV/AIDS to what is happening now with TB and diabetes,” said Prof Anthony Harries, Senior Advisor to The Union. “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.”

Six of the top 10 countries projected to have the greatest numbers of people living with diabetes by the year 2035—China, India, Brazil, Indonesia, Pakistan, and the Russian Federation—are classified as high TB burden countries by the World Health Organization.

Table. Numbers of persons (ages 29-79) projected to be living with diabetes in the year 2035. High TB burden countries shown in bold.

Source: International Diabetes Federation. Diabetes Atlas, 2014. 6^thEdition p34. http://www.idf.org/sites/default/files/EN_6E_Atlas_Full_0.pdf