The double burden of diabetes and global infection in low and middle-income countries

Abstract

Four out of five people in the world with diabetes now live in low- and middle-income countries (LMIC), and the incidence of diabetes is accelerating in poorer communities. Diabetes increases susceptibility to infection and worsens outcomes for some of the world’s major infectious diseases such as tuberculosis, melioidosis and dengue, but the relationship between diabetes and many neglected tropical diseases is yet to be accurately characterised. There is some evidence that chronic viral infections such as hepatitis B and HIV may predispose to the development of type 2 diabetes by chronic inflammatory and immunometabolic mechanisms. Helminth infections such as schistosomiasis may be protective against the development of diabetes, and this finding opens up new territory for discovery of novel therapeutics for the prevention and treatment of diabetes. A greater understanding of the impact of diabetes on risks and outcomes for infections causing significant diseases in LMIC is essential in order to develop vaccines and therapies for the growing number of people with diabetes at risk of infection, and to prioritise research agendas, public health interventions and policy. This review seeks to give an overview of the current international diabetes burden, the evidence for interactions between diabetes and infection, immune mechanisms for the interaction, and potential interventions to tackle the dual burden of diabetes and infection.

Depression and Its Associated Factors among Diabetes Mellitus Patients Attending Selected Hospitals in Southwest Ethiopia: A Cross-Sectional Study

“…In 2017, approximately 5 million deaths among the age of 20-99 years were due to diabetes [4]. Also, a study reported that four out of five people in the world with diabetes live in low-and middle-income countries, and these countries are facing a double burden of diabetes and infec-tious diseases [5]. Depression is also the leading cause of mental health-related diseases and a major contributor to the overall global burden of diseases [6,7].…”

Socio-demographic and clinical characteristics of diabetes mellitus in rural Rwanda: Time to contextualize the interventions? A cross-sectional study

“…The global estimates of the speci c prevalence of the main types of diabetes (type 1 diabetes and type 2 diabetes) are limited by the availability of the sophisticated and costly tests that are required to differentiate the sub-types of diabetes, poor awareness of diabetes among the population and health care providers, and limited access to health care facilities especially in rural populations [9,10]. In LMIC, diabetes is usually classi ed based on clinical characteristics of individuals diagnosed with diabetes and some individuals may not be easily classi ed as having a single type of diabetes [11].Type 2 diabetes mellitus, or insulin-resistant diabetes, is the most common form of diabetes, accounting for more than 90% of the population with diabetes worldwide. As it can be asymptomatic a large proportion is undiagnosed, particularly in low resource settings.…”

Novel multi-component vaccine approaches for Burkholderia pseudomallei

“…pseudomallei is a facultative, intracellular Gram-negative bacillus and the causative agent of melioidosis. Diabetic individuals have a 12-fold increased risk of melioidosis, and more than half of all melioidosis cases have diabetes [6]. The incubation period for melioidosis typically ranges from 1 to 21 days, with a median of 9 days; however, latent infections can occur, with disease manifesting decades after exposure [1][2][3].…”

“…cancer, long-term steroid use and other non-HIV immunosuppressive disorders, are at greater risk for developing disease [5]. Diabetic individuals have a 12-fold increased risk of melioidosis, and more than half of all melioidosis cases have diabetes [6].…”