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Addressing
Diabetes Vital for Tuberculosis Control
Amit
Dwivedi 
Patients with type-2 diabetes may be at increased risk of contracting
tuberculosis (TB) because they generally have a compromised immune
system, which results in life-threatening lung infections that are more
difficult to treat
Research at the University of Texas School of Public Health Brownsville
shows that type 2 diabetes, especially when it involves chronic high
blood sugar, is associated with altered immune response to TB. Patients
with diabetes and TB take longer to respond to anti-TB treatment, and
that patients with active tuberculosis and type-2 diabetes are more
likely to have multi-drug resistant TB (MDR-TB). Almost six percent of
people with diabetes had MDR-TB, reported this study. 30 per cent of
those with MDR-TB also had type 2 diabetes.
According to World Diabetes Foundation (WDF), it was estimated that in
2007 there were 246 million people living with diabetes, 6 million new
cases were diagnosed and 3.5 million people died due to diabetes.
According to the Global TB Control report, published by World
Health Organization (WHO) for the same year, there were 14.4 million
people living with TB, 9.2 million new cases and 1.7 million died due to
this disease. While it is recognized that 95% per cent of TB patients
live in developing world, it is not so well known that 70 per cent of
people with diabetes also live in developing countries, especially in
Southeast Asia
and the pacific region.
India
has a strong TB control programme in the world, referred to as the
Revised National Tuberculosis Control Programme (RNTCP) or Directly
Observed Treatment Shortcourse (DOTS). However, we need to focus more
for its effective implementation. Public- private partnership can
alleviate the problem of TB in people living with diabetes, said Dr
Anthony D Harries, senior advisor, International Union Against
Tuberculosis and Lung Disease (IUATLD, The Union).
Dr Harries was of the opinion that, "there are many risk factors
for TB, which include HIV/AIDS, silicosis, malnutrition and smoking.
While the link between TB and diabetes has been known since roman times,
it is only recently that unequivocal evidence has been gathered to show
a strong association between the two diseases. With an estimated 21
million adults with diabetes and 900000 incident pulmonary tuberculosis
(PTB) cases in 2000, diabetes accounted for nearly 15% of pulmonary TB
and 20% of smear- positive pulmonary TB. Diabetes therefore appears to
increase the risk of active TB."
Dr Harries advocated that "there are three pronged approach for the
DOTS strategy for TB control: 1) identify TB patients through passive
case finding, 2) diagnose TB through sputum smear examination and
3) put the patients on anti-TB treatment."
Dr. Harries further said "In most of the developing countries there
are no systematic ways of monitoring or evaluating patients with
non-communicable diseases (NCD). This has to change. The DOTS framework
for TB control, developed by the IUATLD and WHO, has allowed structured,
well-monitored services to be delivered to millions of TB patients in
some of the poorest countries of the world. In a resource poor-country
like
Malawi
, the DOTS model was successfully adapted for scaling up and monitoring
antiretroviral therapy (ART) to people living with HIV (PLHIV). This
model can be adapted for NCDs, such as diabetes, as well. With treatment
cards and registers, it would be feasible to make comprehensive
quarterly reports on diabetes treatment outcomes, which would include
the monitoring and evaluation of co-morbidities such as TB."
The Millennium Development Goal number 6, specifies that the incidence
of infectious diseases such as TB should be halted and reversed by 2015.
To succeed in achieving this target, it is important to focus on
resource-poor countries not only on for HIV/AIDS but also on the
burgeoning epidemic of diabetes as a significant epidemiological risk
factor.
The
author is a Special Correspondent to Citizen
News Service (CNS). Website: www.citizen-news.org, email: amit@citizen-news.org
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