Diabetes And TB: Do Not Neglect One At Cost Of Other. By Shobha Shukla


The discussions at the recently concluded 41st Union World Conference on Lung Health, in Berlin, brought forth several connections between diabetes and tuberculosis, clearly showing a link between non communicable and communicable diseases. According to Professor Anthony Harries, a seasoned physician and Director, Department of Research, at the International Union Against Tuberculosis and Lung Disease (The Union), "There is very good evidence which suggests that if you have diabetes, the risk of TB is twice than if you do not have it. In terms of diagnosis and treatment also, there is similarity of obstacles. We do not have simple diagnostic tests available for both these diseases."
"To get a blood sugar count done for diabetes is as cumbersome a process as sputum microscopy test for pulmonary TB. There is a more advanced test - glycoselated haemoglobin test - which looks at the blood sugar profile of the last 3 months to test for diabetes. But it is an expensive test and not available everywhere, in the same sense as LED Microscopy and other advanced tests for TB are not there for the common person. Also, monitoring diabetes is perhaps equally difficult. We do not have very good data about what happens to patients of diabetes—how many develop complications, how many actually die at global level. It would be nice to have something like DOTS strategy here also to provide data on the outcome. An electronic monitoring system, very much on the same lines as in HIV/AIDS is needed for people living with diabetes. So, in terms of innovation, we need a point of care test s for both the diseases, which can revolutionize diagnosis and monitoring in resource poor countries. Diabetes, like TB, not only impacts the health of a person, but also the wealth of the affected households, in terms of the number of productive years lost /compromised upon, and the heavy, prolonged cost of treatment" further said Prof Anthony Harries.
Dr Anil Kapur, President of World Diabetes Foundation (WDF) echoes similar sentiments. According to him, "People with diabetes are in a way immune compromised. So the risk of getting TB becomes greater for them, as in the case of HIV/AIDS patients. Hence from the population point of view, diabetes is as relevant in the control of TB as HIV/AIDS. Unfortunately, due to lack of knowledge and information, many people all over the world continue to wrongly perceive diabetes as a disease of affluence. We should not give diabetes the short shrift in TB control programmes. Else we will jeopardise the gains of active case findings and appropriate treatment. If we are not able to control people with TB having diabetes in the background, we will land up with more cases of MDR-TB, and with people remaining infected over a longer period of time, thus causing a reversal of the gains we might have achieved."
The problem of funding is there in both cases, but perhaps more in diabetes. Organizations need to give a fillip to research in this field too. Moreover, while the governments pay for the medicines of a TB/ HIV patient, diabetes treatment costs are not supported by the state. This becomes all the more critical as, contrary to popular belief, diabetes is not a disease of rich people alone. In fact, 70% of the burden of the disease globally exists in poor countries. Let us hope for a change in the general mindset of people. Health professionals should be updated and be aware of the link between diabetes, TB and other co infections. Funding agencies and governments should allocate funds to both in a realistically appropriate manner and not at the cost of each other.
Let one not become the driver of the other.

(The author is the Editor of Citizen News Service (CNS) and also serves as the Director of CNS Diabetes Media Initiative (CNS-DMI). She has worked earlier with State Planning Institute, UP. Email: shobha@citizen-news.org, website: www.citizen-news.org)

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