Indonesian government signs historic Bali Declaration targeting looming co-epidemic of TB and diabetes

New data show 1 in 4 people with TB also have diabetes in hot spots in India

After convening a two-day Summit this week in Bali, the Indonesian Ministry of Health, together with The Union and the World Diabetes Foundation, today signed the Bali Declaration, uniting more than 100 global health officials and experts behind a global campaign to fight the twin scourge of TB and diabetes.

The Declaration follows data presented at the Summit by the Indian initiative Jagran Pehel showing that after bi-directional screening of more than 50,000 people for TB and diabetes in 10 districts from the states of Bihar, Uttarpradesh and Jharkhand between September 2014 and September 2015, one in four people infected with TB was also positive for diabetes.

A total of 51,702 people were screened for TB and diabetes during the period. Among them 1,448 (2.8%) persons had suffered from TB and 3,023 (5.9%) had diabetes. Among those with TB only 539 (37%) of patients had completed TB treatment; while only 507 (16.7%) diabetes patients were on treatment. Among TB patients, 382 (26.4%) were also living with diabetes. (Source: TB and DM linkages campaigns: how beneficial is screening the people attending camps?, Jagran Pehel)

Bi-directional screening is a key component of the Bali Declaration, which aims to bring the co-epidemic to the attention of governments across the globe.

The Bali Declaration states:

  • Tuberculosis and diabetes represent two of the greatest global health challenges of our time, and their convergence globally represents a looming co-epidemic,
  • This looming co-epidemic threatens progress against TB,
  • Based on what we have learned from past co-epidemics, particularly TB-HIV, we must act early and decisively to avoid large numbers of avoidable deaths…

“Today we’re committing to take action to stop this double threat,” said José Luis Castro, Executive Director of The Union. “We have evidence and we have practical solutions, such as providing TB patients with screening for diabetes and vice-versa. In countries facing this challenge, health systems need to take these solutions off the shelf and put them to work.”

Diabetes weakens the immune system, and triples a person’s risk of getting sick with TB—which killed 1.5 million people in 2014, according to a new World Health Organization report. Today, 387 million people are affected by diabetes, with 77 per cent of cases in low- and middle-income countries where TB is prevalent. Diabetes is projected to affect 592 million people by 2035, which experts project will only fuel the global TB epidemic.

“Healthcare systems must prepare to deal with this challenge, particularly in low- and middle-income countries where the challenge is most severe,” said Anders Dejgaard, Managing Director of the World Diabetes Foundation. “It can be done. Leadership in training and advocacy will be essential to ensure that healthcare professionals are equipped to diagnose and take care of these two diseases as they increasingly appear together in the same patients.”  

The Declaration was issued on the heels of a new WHO report showing that due to TB’s slow rate of decline worldwide relative to HIV/AIDS, TB has overtaken HIV as the leading cause of death from an infectious disease.

The Bali Summit convened just a few weeks prior to the 46th Union World Conference on Lung Health in Cape Town, South Africa, the world’s largest gathering of TB experts, advocates and members of TB-affected communities. The conference’s theme, A New Agenda: Lung Health Beyond 2015, reflects in part the changing nature of the TB epidemic. The conference will feature a special session on TB-diabetes following up on the Bali Summit. The conference is expected to draw roughly 3000 delegates from more than 100 countries, including key ministers of health, parliamentarians, and heads of global health financing organisations.

The Bali Summit was hosted by The Union, the World Diabetes Foundation and the Ministry of Health of the Government of Indonesia, with support from Becton Dickinson, Eli Lilly and Qiagen.


How TB and diabetes exacerbate each other

TB and diabetes interact with each other on a number of levels, with each disease exacerbating the other. Diabetes triples a person’s risk of developing TB. Among people who are being treated for TB, those with diabetes remain contagious longer, respond less well to TB treatment and have a significantly higher likelihood of a recurrence of TB after successful treatment or dying from the disease.

TB can temporarily increase the level of blood sugar, a condition known as impaired glucose tolerance, which is a risk factor for developing diabetes. Moreover, some drugs used to treat TB (especially rifampicin) can make it more difficult to control diabetes due to the way that they interact with oral diabetes medications. There are growing concerns that oral diabetes medicines can decrease the effectiveness of TB medicines. Clinicians do not yet know how to optimise glucose control in people who have both TB and diabetes.

TB killed an estimated 1.5 million people in 2014 according to the World Health Organization—making it the world’s leading cause of death from an infectious disease. One in three people worldwide are living with a latent TB infection that could develop into active TB disease at some point in their lives.

Six of the 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 also classified as high TB-burden countries by the World Health Organization.