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‘Diabetes and Tuberculosis’ – A Co-Epidemic of Public Health Importance in the Developing World


Affiliations
1 M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (WHO Collaborating Centre for Research, Education and Training in Diabetes), No. 4, West Madha Church Street, Royapuram, Chennai 600 013, India
 

With the rising epidemic of diabetes mellitus (DM) and tuberculosis (TB) already being a major infectious disease of the world, when put together, this coepidemic constitutes a threat to global public health. The situation is critical in countries like India which are facing the dual burden of non-communicable diseases and communicable diseases. This not only affects the national productivity, but also the national exchequer. Henceforth, a crucial health strategy is required to control this co-epidemic. This article reviews the epidemiology of DM and TB, TB and its characteristics, the effect of DM on TB treatment outcomes, screening methods and diagnosis, economic impact on the health sector and guidelines which could prevent this burden.

Keywords

Diabetes, Developing Countries, Epidemiology, Tuberculosis.
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  • WHO, Global Tuberculosis Report 2015, World Health Organization, Geneva, 2015.

  • International Diabetes Federation. IDF Diabetes, International Diabetes Federation, Brussels, Belgium, 2015, 7 edn; http://www.diabetesatlas.org

  • World Health Organization, Tuberculosis (Fact sheet No. 104); 2016; http://www.who.int/mediacentre/factsheets/fs104/en/

  • Chakraborty, A. K., Epidemiology of tuberculosis: current status in India. Indian J. Med. Res., 2004, 120(4), 248–276.

  • The World Bank Group, Incidence of tuberculosis (per 100,000 people). 2016; http://data.worldbank.org/indicator/SH.TBS.INCD.

  • Stevenson, C. R., Critchley, J. A., Forouhi, N. G., Roglic, G., Williams, B. G., Dye, C. and Unwin, N. C., Diabetes and the risk of tuberculosis: a neglected threat to public health?. Chronic Illness, 2007, 3(3), 228–245.

  • Jeon, C. Y. and Murray, M. B., Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS MED., 2008, 5(7), e152.

  • Raghuraman, S., Vasudevan, K. P., Govindarajan, S., Chinnakali, P. and Panigrahi, K. C., Prevalence of diabetes mellitus among tuberculosis patients in urban Puducherry. North Am. J. Med. Sci., 2014, 6(1), 30–34.

  • Viswanathan, V. et al., Prevalence of diabetes and pre-diabetes and associated risk factors among tuberculosis patients in India. PLoS ONE, 2012. 7(7), e41367.

  • Balakrishnan, S., Vijayan, S., Nair, S., Subramoniapillai, J., Mrithyunjayan, S., Wilson, N. and Willis, M., High diabetes prevalence among tuberculosis cases in Kerala, India. PLoS ONE, 2012, 7(10), e46502.

  • Gupta, S., Shenoy, V., Mukhopadhyay, C., Bairy, I. and Muralidharan, S., Role of risk factors and socio-economic status in pulmonary tuberculosis: a search for the ischolar_main cause in patients in a tertiary care hospital, South India. Trop. Med. Int. Health, 2011, 16, 74–78.

  • Jabbar, A., Hussain, S. F. and Khan, A. A., Clinical characteristics of pulmonary tuberculosis in adult Pakistani patients with coexisting diabetes mellitus. East. Mediter. Health J., 2006, 12(5), 522–527.

  • WHO, Global tuberculosis report, World Health Organizaton, Geneva, 2012.

  • Bates, M. et al., Evaluation of the burden of unsuspected pulmonary tuberculosis and co-morbidity with non-communicable diseases in sputum producing adult inpatients. PLoS ONE, 2012, 7, e40774.

  • Dobler, C., Flack, J. and Marks, G., Risk of tuberculosis among people with diabetes mellitus: an Australian nationwide cohort study. BMJ Open, 2012, 2, e000666.

  • Leung, C. et al., Diabetic control and risk of tuberculosis: a cohort study. Am. J. Epidemiol., 2008, 167, 1486–1494.

  • Walker, C. and Unwin, N., Estimates of the impact of diabetes on the incidence of pulmonary tuberculosis in different ethnic groups in England. Thorax, 2010, 65, 578–581.

  • Pan, S. C., Ku, C. C., Kao, D., Ezzati, M., Fang, C. T. and Lin, H. H., Effect of diabetes on tuberculosis control in 13 countries with high tuberculosis: a modelling study. Lancet Diabetes Endocrinol., 2015, 3(5), 323–330.

  • Syed Suleiman, S. A., Ishaq Aweis, D. M., Mohamed, A. J., Razakmuttalif, A. and Moussa, M. A., Role of diabetes in the prognosis and therapeutic outcome of tuberculosis. Int. J. Endocrinol., 2012, article ID 645362.

  • Leegaard, A. et. al., Diabetes, glycemic control, and risk of tuberculosis. A population-based case-control study. Diabetes Care, 2011, 34, 2530–2535.

  • Vallerskog, T., Martens, G. and Kornfeld, H., Diabetic mice display adaptive immune response to Mycobacterium tuberculosis. J. Immunol., 2010, 184, 6275–6282.

  • Restrepo, B. et al., Tuberculosis in poorly controlled type 2 diabetes: altered cytokine expression in peripheral white blood cells. CID, 2008; 47, 634–641.

  • Martens, G. W. et al., Tuberculosis susceptibility of diabetic mice. Am. J. Respir. Cell. Mol. Biol., 2007, 37(5), 518–524.

  • Handel, A. and Ramagopalan, S., Tuberculosis and diabetes mellitus: is vitamin D the missing link? Lancet, 2010, 10, 596.

  • Alisjahbana, B. et al., The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin. Infect. Dis., 2007, 45(4), 428–435.

  • Singla, R., Khan, N., Al-Sharif, N., Al-Sayegh, O., Shaikh, M. and Osman, M., Influence of diabetes on manifestations and treatment outcome of pulmonary TB patients. Int. J. Tuberc. Lung Dis., 2006, 10, 74–79.

  • Dooley, K., Tang, T., Golub, J., Dorman, S. and Cronin, W., Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. Am. J. Trop. Med. Hyg., 2009, 80(4), 634–639.

  • Perez-Guzman, C., Torres-Cruz, A., Villarreal-Velarde, H., SalazarLezama, M. and Vargas, M. A typical radiological images of pulmonary tuberculosis in 192 diabetic patients: a comparative study. Int. J. Tuber. Lung Dis., 2001, 5(5), 455–461.

  • Umut, S., Tosun, G. A. and Yildirim, N., Radiographic location of pulmonary tuberculosis in diabetic patients. Chest, 1994, 106(1), 326.

  • Bacakoğlu, F., Başoğlu, Ö., Çok, G., Sayıner, A. and Ateş, M., Pulmonary tuberculosis in patients with diabetes mellitus. Respiration, 2001, 68(6), 595–600.

  • Park, S. W., Shin, J. W., Kim, J. Y., Park, I. W., Choi, B. W., Choi, J. C. and Kim, Y. S., The effect of diabetic control status on the clinical features of pulmonary tuberculosis. Eur. J. Clin. Microbiol. Inf. Dis., 2012, 31(7), 1305–1310.

  • Zhang, Q, Xiao, H. and Sugawara, I., Tuberculosis complicated by diabetes mellitus at Shanghai Pulmonary Hospital, China. Jpn. J. Infect. Dis., 2009, 62, 390–391.

  • Kumpatla, A., Achanta, S., Sharath, B. N., Kumar, A. M. V., Harries, A. D. and Viswanathan, V., Characteristics of patients with diabetes screened for tuberculosis in a tertiary care hospital in South India. Pub. Health Action, 2013, 3(1), 23–28.

  • Viswanathan, V., Vigneswari, A., Selvan, K., Satyavani, K., Rajeswari, R. and Kapur, A., Effect of diabetes on treatment outcome of smear-positive pulmonary tuberculosis – a report from South India. J. Diab. Compl., 2014, 8, 162–165.

  • Guler, M., Ünsal, E., Dursun, B., AydIn, O. and Capan, N., Factors influencing sputum smear and culture conversion time among patients with new case pulmonary tuberculosis. Int. J. Clin. Pract., 2007, 61, 231–235.

  • Restrepo, B. I., Fisher-Hoch, S. P., Smith, B., Jeon, S., Rahbar, M. H. and McCormick, J. B., Mycobacterium clearance from sputum is delayed during the first phase of treatment in patients with diabetes. Short report. Am. J. Trop. Med. Hyg., 2008; 79(4), 541–544.

  • Baker, M. A. et al., The impact of diabetes on tuberculosis treatment outcomes: a systematic review. BMC Med., 2011, 9, 81.

  • Jimenez-Corona, M. E. et. al., Association of diabetes and tuberculosis: impact on treatment and post-treatment outcomes. Thorax, 2013, 68(3), 214–220.

  • Gil-Santana, L. et al., Diabetes is associated with worse clinical presentation in tuberculosis patients from Brazil: a retrospective cohort study. PLoS ONE, 2016, 11(1), e0146876.

  • Rani, B., Usha, R., Thyagarajan, K. and Rajeswari, R., Evaluation of an intermittent six-month regimen in new pulmonary tuberculosis patients with diabetes mellitus. Indian J. Tuberc., 2007, 54, 168–176.

  • Rekha, V. B. et al., Sputum conversion at the end of intensive phase of Category-1 regimen in the treatment of pulmonary tuberculosis patients with diabetes mellitus or HIV infection: an analysis of risk factors. Indian J. Med. Res., 2007, 126(5), 452–458.

  • Heysell, S. K., Moore, J. L., Keller, S. J. and Houpt, E. R., Therapeutic drug monitoring for slow response to tuberculosis treatment in a state control program, Virginia, USA. Emerg. Infect. Dis., 2010, 16(10), 1546–1553.

  • Gwilt, P. R., Nahhas, R. R. and Tracewell, W. G.. The effects of diabetes mellitus on pharmacokinetics and pharmacodynamics in humans. Clin. Pharmacokineti., 1991, 20(6), 477–490.

  • Perez-Navarro, L. M., Fuentes-Dominguez, F., Morales-Romero, J. and Zenteno-Cuevas, R., Factors associated to pulmonary tuberculosis in patients with diabetes mellitus from Veracruz, Mexico. Gac. Méd. Méx., 2010, 147(3), 219–225.

  • Fisher-Hoch, S. P. et al., and The Nuevo Santander Tuberculosis Trackers. Type 2 diabetes and multidrug-resistant tuberculosis. Scand. J. Infect. Dis., 2008, 40(11–12), 888–893.

  • Tanrikulu, A. C., Hosoglu, S., Ozekinci, T., Abakay, A. and Gurkan, F., Risk factors for drug resistant tuberculosis in southeast Turkey. Trop. Doctor, 2008, 38(2), 91–93.

  • Baghaei, P. et al., Risk factors associated with multidrug-resistant tuberculosis. Tanaffos, 2009, 8, 17–21.

  • India, Diabetes Mellitus – Tuberculosis Study Group, Screening of patients with diabetes mellitus for tuberculosis in India. Trop. Med. Int. Health, 2013, 18, 646–654.

  • India Tuberculosis–Diabetes Study Group, Screening of patients with tuberculosis for diabetes mellitus in India. Trop. Med. Int. Health, 2013, 18, 636–645.

  • Li, L. et al., Screening of patients with tuberculosis for diabetes mellitus in China. Trop. Med. Int. Health, 2012, 17(10), 1294–1301.

  • Kumpatla, S., Aravindalochanan, V., Rajan, R., Viswanathan, V. and Kapur, A., Evaluation of performance of A1c and FPG tests for screening newly diagnosed diabetes defined by an OGTT among tuberculosis patients – a study from India. Diab. Res. Clin. Pract., 2013, 102, 60–64.

  • Jeon, C. Y. et al., Bidirectional screening for TB and DM – a systematic review. Trop. Med. Int. Health, 2010, 15(11), 1300–1314.

  • Harries, A. D. et al., Defining the research agenda to reduce the joint burden of disease from diabetes mellitus and tuberculosis. Trop. Med. Int. Health, 2010, 15(6), 659–663.

  • Viswanathan, V., Vigneswari, A., Satyavani, K., Selvan, K., Rajeswari, R. and Kapur, A., Effect of a comprehensive training programme for tuberculosis health care providers and tuberculosis patients on diabetes – a report from South India. Int. J. Trop. Dis. Health, 2015, 5(1), 91–100.

  • Laxminarayan, R., Klein, E., Dye, C., Floyd, K., Darley, S. and Adeyi, O., Policy Research Working Paper 4295, World Bank, Washington, 2007. Economic benefit of tuberculosis control.

  • Kenning, C., USAID, PEPFAR, CDC, NIAID, 2010. Leading and Leveraging: US Government Report on International Foreign Assistance in TB FY2010, Published at Centres for Disease Control and Prevention, August 2015; http://www.pepfar.gov/documents/ organization/186203.pdf

  • Kapur, A. and Harries, A. D., The double burden of diabetes and tuberculosis – public health implications. Diabetes Res. Clin. Pract.. 2013, 101(1), 10–19.

  • Bloom, D. E., Cafiero, E. T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L. R. and Fathima, S., The Global Economic Burden of Non-commun. Dis., September 2011. A report of the World Economic Forum and Harvard School of Public Health. (accessed online).

  • Ahn, D. I. and World Health Organization, Addressing poverty in TB control: options for national TB control programmes (WHO/HTM/TB/2005.352), WHO, Geneva, 2005.

  • Coll-Black, S., Van Maaren, P., Ahn, D., Kasai, T. and Bhushan, A., Reaching the poor: challenges for the TB programmes in the Western Pacific Region, A report by WHO regional office for the Western Pacific, 2004.

  • Hanson, C. L., Weil, D. E. C. and Floyd, K., Tuberculosis in the poverty alleviation agenda. Lung Biology Health Dis., 2006, 219(B), 1097.

  • Kamolratanakul, P. et al., Economic impact of tuberculosis at the household level. Int. J. Tuber. Lung Dis., 1999, 3(7), 596–602.

  • Kemp, J. R., Mann, G., Simwaka, B. N., Salaniponi, F. M. and Squire, S. B., Can Malawi’s poor afford free tuberculosis services? Patient and household costs associated with a tuberculosis diagnosis in Lilongwe. Bull. WHO, 2007, 85(8), 580–585.

  • Lönnroth, K., Aung, T., Maung, W., Kluge, H. and Uplekar, M.. Social franchising of TB care through private GPs in Myanmar: an assessment of treatment results, access, equity and financial protection. Health Policy Plann., 2007, 22(3), 156–166.

  • Pantoja, A. et al., Economic evaluation of public-private mix for tuberculosis care and control, India. Part I. Socio-economic profile and costs among tuberculosis patients. Int. J. Tuber. Lung Dis., 2009, 13(6), 698–704.

  • Floyd, K. et al., Cost and cost-effectiveness of PPM-DOTS for tuberculosis control: evidence from India. Bull. WHO, 2006, 84(6), 437–445.

  • Lonnroth, K., Thuong, L., Lambregts, K., Quy, H. and Diwan, V., Private tuberculosis care provision associated with poor treatment outcome: comparative study of a semi-private lung clinic and the NTP in two urban districts in Ho Chi Minh City, Vietnam. Int. J. Tuber. Lung Dis., 2003, 7(2), 165–171.

  • Rangan, W. and Uplekar, M., Socio-cultural dimensions in tuberculosis control. In Tuberculosis: An Interdisciplinary Perspective (eds Porter, J. D. H. and Grange, J. M.), Imperial College Press, London, 1999, pp. 265–281.

  • Long, N. H., Gender Specific Epidemiology of Tuberculosis in Vietnam, Institutionen för folkhälsovetenskap/Department of Public Health Sciences, Karolinska Sjukhuset, 2000.

  • Uplekar, M. and Lonnroth, K., Engaging all health care providers in TB control. Guidance on implementing public-private mix approaches, World Health Organization, 2006.

  • Kapur, A., Harries, A. D., Lonnroth, K., Wilson, P. and Sriwahyuni, L. S., Diabetes and tuberculosis co-epidemic: the Bali Declaration. Lancet Diabetes Endocrinol., 2016, 4(1), 8–10.

  • Suthar, A. B., Zachariah, R. and Harries, A. D., Ending tuberculosis by 2030: can we do it?. Int. J. Tuber. Lung Dis., 2016, 20(9), 1148–1154.

  • Kornfeld, H. et al., High prevalence and heterogeneity of diabetes in TB patients from South India: a report from the effects of diabetes on tuberculosis severity (EDOTS) study. Chest, 2016. 149(6), 1501–1508.


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  • ‘Diabetes and Tuberculosis’ – A Co-Epidemic of Public Health Importance in the Developing World

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Authors

Satyavani Kumpatla
M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (WHO Collaborating Centre for Research, Education and Training in Diabetes), No. 4, West Madha Church Street, Royapuram, Chennai 600 013, India
Vijay Viswanathan
M.V. Hospital for Diabetes and Prof. M. Viswanathan Diabetes Research Centre (WHO Collaborating Centre for Research, Education and Training in Diabetes), No. 4, West Madha Church Street, Royapuram, Chennai 600 013, India

Abstract


With the rising epidemic of diabetes mellitus (DM) and tuberculosis (TB) already being a major infectious disease of the world, when put together, this coepidemic constitutes a threat to global public health. The situation is critical in countries like India which are facing the dual burden of non-communicable diseases and communicable diseases. This not only affects the national productivity, but also the national exchequer. Henceforth, a crucial health strategy is required to control this co-epidemic. This article reviews the epidemiology of DM and TB, TB and its characteristics, the effect of DM on TB treatment outcomes, screening methods and diagnosis, economic impact on the health sector and guidelines which could prevent this burden.

Keywords


Diabetes, Developing Countries, Epidemiology, Tuberculosis.

References





DOI: https://doi.org/10.18520/cs%2Fv113%2Fi07%2F1296-1302