The Director’s Corner

The Director’s Corner

DM-TB – the convergence of two epidemics

A message from José Luis Castro for World Diabetes Day – 14 November 2016

Just a few weeks ago, the World Health Organization (WHO) released data for 2015 showing the global tuberculosis (TB) burden as far higher than previous estimates.

TB, a curable disease, killed 1.8 million people in 2015. This figure represents 300,000 additional deaths compared to the year before, due to the fact India now has a national law requiring it to make TB a reportable disease. These deaths have now been accounted for, and they add to our understanding of the scale of TB’s devastation.

The End TB Strategy aims to reduce TB deaths by 95 percent by 2035, but this goal now looks more distant than ever. If we are to reach it, we must fight a war on many fronts and that includes addressing the threats of co-epidemics including diabetes, HIV, tobacco - and their deadly effect on TB incidence. There is no ‘end TB’ without tackling these co-infections.

Diabetes is a global health emergency, responsible for five million deaths annually and is estimated that about one in seven people with TB also has diabetes. Diabetes triples a person’s risk of developing TB and patients with diabetes have worse TB treatment outcomes and an overall higher risk of dying. Treatment – and accurate diagnosis – of patients affected by both diseases can be challenging, particularly in low-income countries, and diabetes is spreading like fire amongst high TB-burden countries.

We have to have a coordinated approach to how we treat co-epidemics.  One solution is to implement “bidirectional screening” for TB and diabetes, where people diagnosed with TB are screened for diabetes, and, in relevant areas, people with diabetes are screened for TB. For this to be the norm, we need closer collaboration between stakeholders working in infectious and non-communicable diseases.

Action to raise awareness and keep the issue front of mind is therefore vital.  At last month’s 47th Union World Conference on Lung Health in Liverpool, The Union and its partners hosted a full-day symposium entitled, ‘Integrated Care and Research for Tuberculosis, Diabetes and HIV/AIDS: Challenges, Strategies and Clinical Solutions’ which focused discussion on TB co-infections and how the approach to their treatment is an essential strategy to end TB.  More of this joint working and thinking should and must be advocated.

Lastly I would draw your attention to a film, jointly produced by The Union and The World Diabetes Foundation. Made on location in India, it is a short-form documentary that explores real-life stories of patients living with (and the doctors fighting against) the co-epidemic of DM-TB. Their stories show the impact on family structures, livelihoods, wellbeing – and the devastating waste of life. This is not just a disease of numbers. 

Find out more information and see the film here

José Luis Castro, Executive Director, The Union