Feature Multimorbidity

Why India should worry about a coepidemic of diabetes and tuberculosis

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h111 (Published 20 January 2015) Cite this as: BMJ 2015;350:h111
  1. Talha Burki, journalist, London, UK
  1. talhakburki{at}gmail.com

More collaboration may be needed between largely private sector diabetes care and the public tuberculosis control programme, finds Talha Burki

Diabetes is fuelling the spread of tuberculosis warns a report published in October 2014 from the International Union Against Tuberculosis and Lung Disease and the World Diabetes Foundation.1

The report warns of a “looming co-epidemic,” which could have catastrophic consequences for healthcare systems in affected countries. With the world’s highest burden of tuberculosis—an estimated 65 million cases—India is especially vulnerable.2

Type 2 diabetes triples the risk of tuberculosis.1 The World Health Organization estimates that one million new cases of tuberculosis globally a year can be attributed to the condition—15% of the total burden.3 In India, this translates to about 300 000 cases of tuberculosis associated with diabetes a year. Patients with diabetes are four times more likely to relapse and twice as likely to die during treatment for tuberculosis.3 They remain infectious for longer and are less receptive to drugs.1

Interaction between drugs

“In the presence of diabetes, the pharmacokinetics of many anti-TB drugs are affected,” explained Anil Kapur, former managing director of the World Diabetes Federation and now a member of its board. “Efficacy levels might go down quite substantially.” All of which raises the possibility that such patients could drive a new cycle of infection and drug resistance. “Unless you deal with diabetes, you cannot provide optimal outcomes for tuberculosis,” stressed Kapur. “It is important that policymakers and those who implement the programmes on the ground are aware of this fact.”

Research into coexisting tuberculosis and diabetes …

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