For centuries, tuberculosis worked alone. And then AIDS surfaced. HIV/AIDS makes it easier for TB to step in and do its work by suppressing immune systems. Now it is teaming up with diabetes to inflict greater harm, according to a new study, and the impact could span the globe.
Diabetes rates are rising everywhere; a part of an overall increase in non-communicable diseases. As the world gets better, more people suffer lifestyle diseases. These include diabetes and heart disease, and other ailments that go along with a population that is living longer, like cancer.
The non-communicable diseases burden in low-income countries is expected to increase to 69 percent by 2020, from 47 percent in 1990. That is cause for concern by itself. Some 384 million people have diabetes and it will reach nearly 600 million cases by 2035. The diseases often associated with unhealthy diets, is particularly burdensome in low- and middle-income countries, where more than 80 percent of the 3.4 million annual diabetes deaths occur.
Toss in the potential for increased risk of TB and things get worse. The risk of contracting active TB is up to three times higher for people who have diabetes, also making them carriers of a contagious and potentially deadly infection.
Immediate action is needed to fend off a “looming co-epidemic,” according to a report released by The Union and the World Diabetes Foundation.
“In places where this issue has been studied — from India to China to East Africa and the United States — we’re seeing significantly higher rates of diabetes among TB patients than what appears in the general population. If we don’t act now to head this off, we’re going to experience a co-epidemic of TB-diabetes that will impact millions and sap public health systems of precious resources. The key is to prevent this from happening,” said Dr. Anil Kapur, member of the board of directors of the World Diabetes Foundation.
Of the 10 countries that are projected to have the most number of diabetes cases in 2035, six are also WHO classified high TB-burden countries: India, Brazil, Indonesia, Pakistan and Russia. The call to action from the Diabetes Foundation focuses on the six countries where the two problems intersect. Preventing a co-epidemic will require health officials to deal with TB and diabetes together. The report focuses its recommendations on increasing funding for the response, as well as more money for research and development into the to diseases. Much of it will require coordination in much the same way that health officials are dealing with TB and HIV at the same time.
India, for example, is studying the implementation of what is called bidirectional screening. People who have either TB or diabetes are then screened for possible co-infections. This brings together health resources to address multiple health problems at the same time. There is work to be done in order to make it efficient, but a study conducted in India to determine when to refer diabetes patients to get TB testing helps show a way forward. There is room for improvement when it comes to screening questions, but The Union sees it as promising progress.
While the connection between TB and HIV/AIDS now has the world’s attention, it was not always the case. The call to action when it comes to diabetes and TB carries the hopes that action will start sooner this time around.
“For years we had a policy framework for responding (to the TB and HIV/AIDS co-infection). But it took years to mobilize a robust response, and millions of people were impacted by TB-HIV co-infection before it became the norm to screen people living with HIV for TB and vice-versa,” said Dr. Anthony Harries, Senior Advisor to The Union.
“We want to raise an alarm that we don’t watch history repeat itself with TB-diabetes.”