TB-diabetes combine poses new threat, say experts

More than 100 global health officials and experts have joined a new global campaign to fight the “twin scourge” of TB and diabetes.

At the end of a two-day summit in Indonesia on Tuesday, they drew the attention of governments across the world to the fact that patients having both TB and diabetes represented a “looming co-epidemic”.

The Indonesian Ministry of Health, together with the International Union Against Tuberculosis and Lung Disease (The Union) and the World Diabetes Foundation signed ‘Bali Declaration’ in this regard following statistics presented by India at the summit.

The Indian initiative ‘Jagran Pehel’ showed that one in four people infected with TB also tested positive for diabetes in 10 districts from the states of Bihar, Uttar Pradesh and Jharkhand.

Both TB and diabetes are common among Bangladeshis, too. So, their coexistence could be widespread, though Bangladesh lacked indicative statistics.

A senior adviser and research director of The Union, Dr Anthony Harries, agreed.

“We need to know more about the dual epidemic in Bangladesh – what proportion of TB patients have diabetes and what is the TB case rate amongst diabetes patients. This information could be obtained through simple operational research or surveys,” he told

bdnews24.com in an email interview.

Harries is a UK-based physician and a specialist on infectious diseases and tropical medicine.

He stressed on understanding the co-interactions within the countries.

“It is like the early days of the HIV epidemic - we need to know and this helps WHO to prioritise on its indicators,” he said.

The ‘Bali Declaration’ stressed on ‘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 he or she has 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 cough, weight loss and fever, and, if the answer is yes, investigations are done for TB.

Dr Harries said the ‘Bali Declaration’ raised hopes for developing countries like Bangladesh in dealing with the looming epidemic.

“It is a call for action from the highest levels to the peripheral health levels. We hope this will persuade people who make decisions about finances and resources to act,” he said.

Diabetes weakens the immune system, 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 by diabetes, with 77 per cent of cases in low- and middle-income countries, where TB is prevalent.

Diabetes is projected to affect 592 million people by 2035, which, according to experts, will only fuel the global TB epidemic.

 “Healthcare systems must prepare to deal with this challenge, particularly in low- and middle-income countries where the challenge is most severe,” Managing Director of the World Diabetes Foundation Anders Dejgaard was quoted as saying in a statement after the Declaration.

“It can be done. Leadership in training and advocacy will be essential to ensure that healthcare professionals are equipped to diagnose and take care of these two diseases as they increasingly appear together in the same patients”.

The Declaration was issued on the heels of a new WHO report showing that due to TB’s slow rate of decline worldwide compared to HIV/AIDS, it has overtaken HIV as the leading cause of death from an infectious disease.

The Bali Summit was convened just a few weeks before the 46th Union World Conference on Lung Health in Cape Town, South Africa, the world’s largest gathering of TB experts, advocates and members of TB-affected communities.

Themed on ‘A New Agenda: Lung Health Beyond 2015’, the conference reflects in part the changing nature of the TB epidemic. It will feature a special session on TB-diabetes as a follow up to the Bali Summit.

The conference is expected to draw roughly 3,000 delegates from more than 100 countries, including key ministers of health, parliamentarians, and heads of global health financing organisations.

“Today we’re committing to take action to stop this double threat,” Executive Director of The Union José Luis Castro said at the end of the Bali summit.

“We have evidence and we have practical solutions, such as providing TB patients with screening for diabetes and vice-versa. In countries facing this challenge, health systems need to take these solutions off the shelf and put them to work”.