TB-Diabetes in Asia Pacific
[Watch CNS Video featuring interview with Dr Anthony D Harries] In an interview given to Citizen News Service (CNS) at the conference, Dr Anthony D Harries, Director, Department of Research, International Union Against Tuberculosis and Lung Disease (The Union), said that TB-diabetes problem is indeed a formidable challenge in the Asia Pacific region. TB is a big problem in many West Asian countries and diabetes is a looming epidemic globally, more so in many West Asian countries, as a result of urbanization, changing life styles and TB. When these two epidemics meet and overlap, it causes a significant problem.
Dr Harries reiterated that, "It is a two-way system. Studies show that people with both type-1 (insulin dependent) and type-2 (related to obesity, high blood pressure) diabetes have 2-3 times higher risk of getting TB compared to normal people, perhaps because diabetes suppresses immunity and these people cannot contain infection as well as normal people - one of them being TB. On the other hand, while TB does not cause diabetes, it stresses the system and in the process increases the body's blood sugar levels, thus unmasking diabetes in people who are borderline cases."
Bidirectional screening
While there is already a collaborative TB-diabetes framework produced by the World Health Organization (WHO) and The Union, Anthony feels that it is high time there is more action on the ground.
"All TB patients should be tested for diabetes, even if the patient says he/she does not have diabetes (50% of the people in the world who have diabetes do not know their status). There needs to be a policy decision on this for all countries of the region. At the same time we would advocate that in diabetes clinics of those countries, which have high incidence of TB, it would worthwhile screening diabetes patients for TB. Studies done in China and India have shown that if we screen for TB in diabetes clinics, we are likely to pick up more TB than in normal population. So it would be worthwhile to do this, as diabetes clinics are one of the many hotspots where we can find some of the 3 million missing TB cases that are currently lost by national TB programmes. But this may be easier said than done. We have to be careful while screening diabetes patients for TB, as still there is a lot of stigma attached with TB. So one can casually ask people with diabetes if they have symptoms like coughing for more than 2 weeks, fever, weight loss, night sweat, and then take the matter up further if need be. So bi-directional screening must be done - put policy into action," he said.
Shobha Shukla, Citizen News Service -- CNS
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