Video interview with Dr Anthony Harries is online at (be welcome to use it): https://www.youtube.com/watch?v=PF9bILRWv1c
TB is the top infectious disease killer that infected 9 million people, killing 1.5 million of them, in 2013. The Asia Pacific region carries 56% of this global TB burden, accounting for 5 million TB cases, and more than half a million TB related deaths in 2013. According to the Diabetes Atlas 2014, diabetes affects 387 million people worldwide out of which 213 million are in the Asia Pacific region. in 2014, diabetes killed 4.9 million people worldwide out of which 3 million (60%) were in the Asia Pacific Region.
About 15% of all TB cases are linked to diabetes. During the recently concluded 5th Asia Pacific Region Conference on Lung Health of the International Union Against Tuberculosis and Lung Disease (The Union), Dr Richard Brostrom, State TB Branch Chief and Pacific Regional Medical Officer of Centers for Disease Control and Prevention (CDC), gave some very interesting but grim statistics regarding the nexus between TB and diabetes. He said that, "People with diabetes on being infected with TB have a 2 times higher risk of remaining culture positive; 3 times higher risk of progression to active TB disease from latent infection; 4 times higher risk of relapse after completing standard TB treatment; and 5 times higher risk of death during TB treatment, as compared to those without diabetes."
TB-diabetes co-morbidities are now one of the priorities both in clinical and public health aspects. Several studies confirm the necessity of taking this issue seriously if we aim to have a TB free world.
One such study on 'Detection of TB among diabetes patients to reduce the burden of TB - diabetes mellitus (TB-DM) co-morbidities in Bangladesh' was presented by Dr Mohammed Sayeedur Rahman at the aforesaid conference. Dr Rahman informed that:
There are 5.9 million people suffering from diabetes in Bangladesh and their number is increasing by 5%--6% each year. Considering the increasing number of populations at risk of both diseases, the combination of TB and DM signifies a health warning for Bangladesh.
The objective of the study was to implement collaborative activities to reduce the burden of TB-DM by increasing early case detection and management of TB among DM patients and developing knowledge and awareness on TB- DM co-morbidities among the health professionals.
The USAID TB CARE II project, Bangladesh has been supporting Diabetic Association of Bangladesh (DAB) to increase access to TB services for diabetes patients by improving prevention, early case detection and quality of care, thereby contributing to reduction in mortality and morbidity rates due to TB-diabetes by integrating TB services into diabetes delivery services.
The key activities include early detection of TB in diabetes patients through active screening of diabetes patients and quality of care for patients with TB-DM. As a result, total case notification of all forms of TB among diabetes patients increased manifold - from 337 cases notified during April-December in 2013 to 1119 cases in January - December 2014.
Moreover, DAB (i) oriented 811 health professionals from BIRDEM and affiliated hospitals on screening and management of TB among diabetes patients; (ii) developed a National guideline on management of TB-DM co- morbidities; (iii) provided regular counseling to diabetes patients to sensitize them about increased risks of TB infection and early care seeking for TB services.
Another study presented by Dr Abdul Razak Muttalif of Institute of Respiratory Medicine, Kuala Lumpur Hospital, Malaysia, compared treatment outcomes among TB patients in four states (Penang, Sabah, Sarawak and Selangor) with and without diabetes. The study results showed that:
- 24.4% of the TB patients had diabetes also, which was twice as high as reported by a previous study.
- A very high percentage of TB-DM patients had poorer treatment success rate with the odd ratio for treatment success rate among them being 0.63 with 95% confidence interval.