Defining the research agenda to reduce the joint burden of disease from Diabetes mellitus and Tuberculosis

Abstract

The steadily growing epidemic of diabetes mellitus (DM) poses a threat for global tuberculosis (TB) control. Previous studies have identified an important association between DM and TB. However, these studies have limitations: very few were carried out in low-income countries, with none in Africa, raising uncertainty about the strength of the DM-TB association in these settings, and many critical questions remain unanswered. An expert meeting was held in November 2009 to discuss where there was sufficient evidence to make firm recommendations about joint management of both diseases, to address research gaps and to develop a research agenda. Ten key research questions were identified, of which 4 were selected as high priority: i) whether, when and how to screen for TB in patients with DM and vice versa; ii) the impact of DM and non-DM hyperglycaemia on TB treatment outcomes and deaths, and the development of strategies to improve outcomes; iii) implementation and evaluation of the tuberculosis “DOTS” model for DM management; and iv) the development and evaluation of better point-of-care diagnostic and monitoring tests, including measurements of blood glucose and glycated haemoglobin A1c (HbA1c) for patients with DM. Implementation of this research agenda will benefit the control of both diseases.

Effect of Anti-tubercular Drugs and Impact of Glycemic Status in Patients with Tuberculosis and Concomitant Diabetic- Tuberculosis Patients

“…The tobacco smoke and alcohol abuse are major risk factors which reduces the effectiveness of TB treatment and increases prevalence of TB. 3,7,9 Among the patients with DM in anti-TB therapy around 90% cases were pulmonary tuberculosis with 70% sputum positive cases. The studies done earlier had shown a high percentage of sputum positivity and a higher rate of pulmonary TB than extra pulmonary tuberculosis in diabetic patients.…”

“…It is estimated that annually around 3,30,000 Indians die due to TB. 3 An association between diabetes and TB is biological plausible, for diabetes impairs the immune system, making it harder for the body to fight against infection. 4 Clinicians have observed an association between DM and TB, although they were often unable to determine whether DM caused by TB or whether TB led to the clinical manifestations of DM.…”

Cross-sectional assessment reveals high diabetes prevalence among newly-diagnosed tuberculosis cases

“…These findings reveal that diabetic patients with TB are not new to the health-care system and highlight the fact that opportunities for preventing TB among diabetes patients are often missed. While not all diabetes patients with latent TB infection should take prophylactic treatment, 36 such patients should be made aware of their risk of TB and should discuss with their physicians the potential risks and benefits of taking preventive anti-TB treatment. Our findings and what is currently known about the natural history of TB suggest that people with a history of diabetes and its complications who have had recent contact with a TB patient are prime candidates for preventive treatment.…”

Prevalence, Predictors and Treatment Outcome of Type 2 Diabetes among Newly Diagnosed Sputum Positive Pulmonary Tuberculosis Patients in Western Cameroon

“…As recently reviewed, little is known about the prevalence of diabetes in TB burden countries [8] and none or little studies on the role of diabetes for TB have been carried out in Africa. In addition, a recent study in Taiwan, showed that diabetes was the most common underlying co-morbidity in patients with culture-confirmed TB, present in 21.5% of patients [9] and among patients afflicted with both TB and DM, diabetes was reported to be associated with poor TB treatment outcomes [10][11][12].…”