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Diabetes and tuberculosis (TB) have existed for thousands of years. Today, the global burden of disease from diabetes and TB is huge and, in the case of diabetes, rapidly increasing. Recent systematic reviews show that diabetes is associated with an increased risk of TB, yet the potential public health and clinical importance of the association seems to be largely ignored. Irrespective of whether the association is causal or a result of co-morbid factors, in low-resource societies with a dual disease burden, can a common health system approach for diabetes and TB be adapted to address prevention and care? How and to what extent can this be done? Good-quality implementation research is urgently needed to create robust action plans to address this double burden. KeywordsDiabetes, tuberculosis (TB), co-morbidity, public health, clinical implications, millennium development goals (MDGs) Intersecting EpidemicsDiabetes and tuberculosis (TB) have existed for thousands of years.Great physicians in the ancient civilisations of Egypt, India, Greece and Rome described an illness that we now understand as diabetes.Similarly, the earliest evidence of TB has been found in the skeleton of a 30-year-old woman in Italy, dated to 5,800BCE.1 The term 'phthisis', or consumption, first appeared in Greek literature, and around 460BCEHippocrates identified phthisis as the most widespread and invariably fatal disease of the times. The co-morbidity of diabetes and TB was also well known in those times. Richard Morton's Phthisiologia: or a treatise on consumption, written in 1694, stated that an association between the two conditions was suggested even in Roman times. 2The great Indian physician Susruta in about 600CE was aware of the association, and Avicenna in about 800CE commented that phthisis frequently complicated diabetes. The risks were higher in young people and in countries with a high background incidence of TB. Another systematic review reported

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