A recently conducted study by the WHO indicates that there is a very high link between diabetes and tuberculosis. The study found that over 50% who suffer from TB are diabetics; this might be due to their weakened immune systems. To counter this WHO feels that there needs to better surveillance of diabetics in TB-endemic regions.
The study was conducted in Kerala by WHO. Among 552 TB patients screened, 243 (44%) had diabetes — 128 (23%) previously-known diabetics and 115 (21%) newly-diagnosed — with higher prevalence among males and those above 50 years. Of the 128 TB patients with previously-known diabetes, 107 (84%) had HbA1c — more than 7% indicating poor glycemic control.
Dr Anoop Misra, chairman Fortis Centre for Diabetes, Metabolic Diseases and Endocrinology, said, ‘India should routinely start screening diabetics for TB and TB patients for high blood sugar. It is important for countries like India where numbers of both the diseases are enormous, with TB and diabetes fuelling each other. It is important to look for both these diseases and aggressively treat them.’
The WHO in its World TB Report, 2012, said people with a weak immune system, as a result of chronic diseases such as diabetes, are at a higher risk of progressing from latent to active TB.
Latent TB affects one in three persons in the world. People infected with latent TB have a life-long risk of developing TB. According to WHO, people with diabetes have a two-three times higher risk of TB compared to non-diabetics.
About 10% of TB cases globally are linked to diabetes. The WHO recommended that all TB patients should be screened for diabetes. ‘Screening for TB in people with diabetes should be considered, particularly in settings with high TB prevalence. People with diabetes who are diagnosed with TB have a higher risk of death during TB treatment and of TB relapse after treatment. WHO-recommended treatments should be rigorously implemented for people with TB/diabetes. Diabetes is complicated by the presence of infectious diseases, including TB,’ WHO said.
‘A large proportion of people with diabetes as well as TB is not diagnosed, or is diagnosed too late. Early detection can help improve care and control of both,’ it added.
There is a need to set up a constant watch of people who suffer from diabetes and TB. WHO asked all countries to carry out diabetes checks in medium and high TB-prevalent environments. Countries have also been asked to screen TB patients for diabetes and ensure high-quality diabetes management among TB patients. The Kerala study says that while diabetes is a known risk factor for TB, the prevalence among TB patients in India is unknown.
At present globally, more than 9 million people fall sick with TB every year while over 1.5 million die from it. On the other hand, 350 million people have diabetes with over 80% of diabetes deaths occurring in low and middle-income countries. It is predicted that global diabetes prevalence will increase by 50% by 2030.