World Diabetes Day – the Union’s ongoing work to defeat a growing global threat

On World Diabetes Day, we want to highlight our work on a pilot tuberculosis-diabetes mellitus (TB-DM) project in Kampala, Uganda and raise awareness of the growing threat of TB-Diabetes.

The number of people with diabetes has risen from 108 million in 1980 to 422 million in 2014. It is estimated that about one in seven people with TB also has diabetes. Treatment – and accurate diagnosis – of patients affected by both diseases can be challenging, particularly in low- and middle-income countries.

Since January 2016, The Union has implemented, in partnership with the Ugandan Ministry of Health Non-Communicable Disease programme, the National TB Leprosy Programme and Kampala Capital City Authority, a pilot TB-DM project in Kampala, Uganda. The project is funded by the World Diabetes Foundation (WDF), and has been implemented since January 2016 in both Uganda and Zimbabwe.

The project provides active screening and chronic diabetes care in 10 locations in urban settings, where rates are known to be high, and lifestyle factors that are established diabetes risks are prevalent. All patients diagnosed with TB, including children, are tested for diabetes at these facilities, as part of the screening process.

The Union’s Dr Joseph Nsonga has been instrumental in the implementation and running of the project - the first of its kind in the country. He said:

“Before this project, screening was not done for diabetes. As we carry out the study, we are looking at diabetic patients, what drugs are used and the interactions with TB medications. At the end of the study we expect to have a better understanding of the prevalence of the disease in Uganda and we will know better about the treatments needed.”

The project has, in 18 months, resulted in the screening of 2,879 TB patients for DM. Diagnosing 64 TB patients with DM and providing them with ongoing chronic care.

Noah Waigolo is a Comprehensive Nursing Officer at one of the centres running the project, the Kawaala Health Centre in Kampala, Uganda.

“The diabetes screening is important because before now, screening was done for TB and HIV, but a patient might be treated for these diseases and not respond because of underlying diabetes.”

“Now, every patient that comes in where we suspect TB, we diagnose also for diabetes. The first time we have contact with the patient we blood test there and then. If blood glucose is high we need take another test before they eat.

“After two weeks, we repeat the test and this confirms the diagnosis. Then we consult with clinicians and provide counselling and supportive treatment, as well as the drugs needed.”

Noah explains that the relationships with patients are an important part of the project, providing insight into the condition. 

“Diabetes is a painful condition, it is important that we understand the patient’s experience, and what they are going through. Through helping these people, we become close – like brothers and sisters”, Noah says.

He explains that people who have been cured and treated become allies in helping educate others, returning to their communities to encourage others to understand the conditions and to seek treatment.

Noah is positive about the project: “I feel happy that we are bringing the fight against TB-DM to the level of TB-HIV.”

Alone Lubwama is a 34 year old farmer living in the Kawaala district. He was treated and cured of TB but developed symptoms again in July this year.

“I was too weak to go to the health centre myself, a friend took me there.” Alone recalls.

At Kawaala Health Centre the new screening programme tested him and discovered his high glucose, he has been diagnosed with TB-DM and is now receiving treatment. 

“I was not scared, when I was diagnosed with diabetes at Kawaala, because I had already experienced treatment for TB there.”

His illness has weakened him, and it prevents him being able to work to support his family. His crops fail; his debts accrue; his children cannot go to school this term, for lack of money.

“The condition has affected me so much, it has weakened me. I worry about not being able to work or take my crops to market and how to support my family, money is a constant worry.  The project has helped so much, in providing support and the drugs, free of charge.” Alone says.

Poverty is a determinant factor for diseases like TB and diabetes. The management of diabetes requires a change to diet, for instance, that many patients in low- and middle income – countries can’t necessarily afford.  Poverty and disease, like TB and diabetes, exist in a cycle of mutual causality, but projects like the TB-DM program intervene in this cycle and provide support, education and treatment.

Dr Joseph Nsonga expects this pilot project to provide valuable insight into treating TB-DM and to continue to save lives.

“Through implementing training and education and screening for diabetes we have managed to stop patients being missed, patients that before may have died; also, we are able to evaluate how one disease leads to the other. A patient we know has TB might develop diabetes (and vice versa) and we can look at and understand the relationship between these diseases and prevent and treat them effectively.”

“We collect the data and see how patients have responded to treatment, which will go on to inform our approach to TB-DM”, Dr Nsonga says.