Diabetes and Tuberculosis – Old Associates Posing a Renewed Public Health Challenge

Abstract

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

Prevalence and Associated Factors of Diabetes Mellitus among Tuberculosis Patients in South-Eastern Amhara Region, Ethiopia: A Cross Sectional Study

“…Historically, the association between tuberculosis (TB) and diabetes mellitus (DM) is well known and was of great concern for clinicians and investigators at the dawn of the 20 th century. The influence of DM on TB was, however, neglected after the discovery of potent treatment regimens for both diseases [ 1 – 4 ]. Currently, the association between DM and TB is re-emerging worldwide.…”

“…DM directly impairs innate and adaptive immune responses that are necessary to counter the progression from infection to clinical diseases [ 8 ]. The association between DM and TB is supported by the fact that patients with DM have impaired cell-mediated immunity, renal failure, micronutrient deficiency and pulmonary microangiopathy, all of which increase their susceptibility to develop TB disease [ 4 , 8 – 9 ]. Studies conducted in different parts of the world have shown that 12%-44% of TB diseases were associated with DM [ 10 – 15 ].…”

Risk factors of pulmonary tuberculosis among diabetes mellitus patients in Denpasar City

“…10 In addition, high level of HbA1c induces deterioration of TB patients leading to increased mortality. 11,12 This study suggests that screening TB among DM patients should be performed regularly especially among those who have poor glycemic control.…”

Risk factors of pulmonary tuberculosis among diabetes mellitus patients in Denpasar City

“…10 In addition, high level of HbA1c induces deterioration of TB patients leading to increased mortality. 11,12 This study suggests that screening TB among DM patients should be performed regularly especially among those who have poor glycemic control. This study also revealed that malnutrition is a risk factor of TB comorbidity among DM patients.…”