Bangladesh must wake up to TB-diabetes co-infection threat, says expert

Last month global health officials and experts in a summit in the Indonesian capital of Bali flagged that patients having both TB and diabetes represented a “looming co-epidemic”.

Nurul Islam Hasib from Cape Townbdnews24.com
Published : 5 Dec 2015, 04:26 PM
Updated : 5 Dec 2015, 05:38 PM

Diabetes upsets immunity, and triples a person’s risk of contracting TB – which killed 1.5 million people in 2014, according to a new World Health Organisation report.
 
Today, 387 million people are affected worldwide by diabetes, with 77 percent of cases in low- and middle-income countries, where TB is also prevalent.
 
Is this co-infection a problem for Bangladesh where both TB and diabetes are common?
 
Dr Anthony Harries, globally known as an expert on this new threat, believes the Bangladesh government should wake-up to this.
 
He advised “a situational analysis” to understand the co-infection, while talking to bdnews24.com on the sidelines of the ongoing 46th Union World Conference on Lung Health in Cape Town.
 
A UK-based physician and a specialist on infectious diseases and tropical medicine, Harries is a senior adviser and research director of The Union that works on lung health.
 
He says this co-infection can frustrate the world community’s ‘end-TB’ target to cut TB deaths by 90 percent, reduce new cases by 80 percent and end treatment related financial hardship by 2030.
 
Harries said programme approaches would need a “massive change” as globally it was possible to reduce TB by 18 percent in the last 15 years with a reduction rate of just around 1 percent a year.
 
To reach the 2030 target, the efforts must be six times more.
 
“In the new approaches we have to identify risk factors. In Africa, the big problem in TB control is HIV.  But in Bangladesh HIV is not such a problem.
 
“Bangladesh, India, China, Pakistan, Indonesia, and Philippines have growing epidemic of diabetes,” he says.
 
He said diabetes was growing among the urban poor because of the changing lifestyle, food habits, lack of exercise, and “probably (urban poor) have a genetic predisposition of getting diabetes if they take wrong food”.
 
“So if you have diabetes increasing in the urban poor, you have TB spreading because of close crowding and poor ventilation, bad diet and malnutrition.
 
“You got a problem,” he says. “In urban Bangladesh they can interact.”
 
“So the current rate of 1 percent decline (of TB) may even stop, and we may fail to meet the UN target of ending TB.
 
“If you have diabetes and TB, it worsens your treatment outcome.
 
“You take longer to become non-infectious on TB drugs. You have higher chance of failing TB treatment. You have a higher chance of dying on TB treatment.
 
“This also increases the chances of getting TB again because of diabetes, even after being cured.
 
“You have diabetes…your sugar is not controlled, your chance of reducing TB are severely diminished. We have to wake up to this,” says the expert.
 
He suggests ‘bi-directional screening’ for the simultaneous detection of TB and diabetes, a method that screens TB patients for diabetes and diabetes patients for TB.
 
TB patients are asked whether they have diabetes and if the answer is no, then screening is done with a blood test for glucose.
 

Similarly, diabetes patients are asked about the key TB symptoms such as persistent cough, weight loss, fever, and sweating and, if the answer is yes, investigations are done for TB.
“With this, we can identify the missing cases as globally half of the people don’t know they are diabetic and a third do not know about their TB.”
He says the Bangladesh government, for a situational analysis, needs to support some routine studies in the field and screen TB patients for diabetes.
He says such studies in Asian countries revealed a much higher rate of diabetes among TB patients.
“If it’s so in Bangladesh, then the government should think seriously about a policy for screening TB patients for diabetes to identify the disease and to treat it properly.”