Reduce diabetes to reduce TB

Public health managers have a new policy on tuberculosis. The advice to reduce tuberculosis in the world is to first reduce diabetes.

Tuberculosis (TB) continues to be a major public health challenge affecting 9 million people annually. Of those, 1.5 million die each year from TB. The risk factors associated with TB include HIV, smoking, malnutrition, poverty, and now – recently confirmed – diabetes.

Diabetes is on the rise, with an estimated 600 million people that will be affected during the next 20 years. Diabetes affects low-to-mid income-level countries most – and it is these countries that have around 80% of the world’s TB cases. What can be done globally to address this issue? Reduce diabetes to reduce TB – that’s the current global public health campaign.

The Millennium Development Goals (MDG) have been successful in halving the prevalence and mortality from TB, and reducing the number of cases in most regions in the world. This is due to TB programs supported by the World Health Organization, the World Bank, and other major donors and agencies.

Are we facing a TB-diabetes co-epidemic?

The new five-year MDG goals that will be announced in September 2015 will build upon their previous goals to reduce TB. The new ‘End TB Strategy’ focuses on integrated patient-centered  TB care and prevention, supportive systems, and research. The new targets are: to reduce TB deaths by 95%, to cut new cases by 90%, and to ensure that no family is burdened with expenses due to TB by 2035.

But with the news that diabetes and TB are connected, are we facing a TB-diabetes co-epidemic? The International Diabetes Foundation estimates the prevalence of diabetes to increase by 10% in the next 20 years. Diabetes weakens the immune system and accelerates the breakdown of those infected with TB to ‘active disease’ status. Diabetes itself causes death, but it likely to accelerate the number of TB cases, and TB-related deaths.

The countries in which TB is rising include: India, China, Indonesia, Pakistan, and Brazil. What can we do to reduce diabetes to reduce TB? The first step is to implement the WHO collaborative framework that prioritizes countries at higher risk and advocates national TB and diabetes programs. This would ensure that all patients are screened for diabetes, and that all diabetes patients should be screened for symptoms of TB periodically. The second step is to improve diabetes programs. While most countries have reasonable TB programs with (free) diagnostic services, diabetes programs are not yet robust. Additional resources are needed to strengthen diabetes programs. This includes developing standardized management protocols, training, test kits, drugs, and a monitoring and follow up mechanism.

So what is our call to action for the global development community? The 2014 World Lung Conference in Barcelona, Spain, distributed a report on the potential TB-diabetes co-epidemic – and this should be the starting point for advocating the integration of TB and diabetes control programs. In July 2015 there will be the International Financing for Development Conference in Addis Ababa, Ethiopia, to discuss financing models – and aligning the budgets for TB and diabetes programs is another excellent starting point.

For individuals considering donating to health causes, questions can be asked about co-linked programs that deal with TB and diabetes prevention. We need to reduce diabetes – personally, locally, and globally – to reduce tubercolosis.