18. Mar 2014

Diabetes growth may reverse tuberculosis trends

In the Millennium Development Goals (MDGs) formulated in the 1990s, goal 6 set a target to halt and reverse the incidence of TB from 1990 to 2015. According to the World Health Organization the TB incidence rate has been falling worldwide the last decade, meaning that the MDG target has been achieved globally. Yet, there is reason to pay attention to the growing diabetes burden worldwide as diabetes may affect the tuberculosis incidence – and hence reverse the achievement for MDG 6.
Inside a mobile van a WDF project worker from M.V. Hospital for Diabetes in Tamil Nadu, India, is instructing a TB worker in how to take blood sample from the TB patient for diabetes.

A supplement on tuberculosis and diabetes was published in the November 2013 edition of The Union’s free online journal Public Health Action. This supplement can now be freely downloaded from our website or accessed online. In the supplement researchers share their findings from DM-TB projects in India – some of which have been supported by WDF.

Background for the supplement (excerpt from the editorial)
In September 2011, a national stakeholders meeting was held in Delhi, India, about bi-directional screening of tuberculosis (TB) and diabetes mellitus (DM). Agreement was reached about how to implement, monitor and report data. The meeting was followed by training of health care personnel, implementation of screening and exchange of data and challenges.

Policy links national TB and NCD programmes in India
This body of work culminated in two published papers presenting the process and aggregating data on bi-directional screening of TB and DM in India. This led to changes in policy and practice: A policy directive has been issued that all patients registered with TB in India should be screened for DM.

Moreover, a policy directive from the Directorate General of Health Services now links India’s Revised National TB Control Programme to the National Programme for Non-Communicable Diseases (NCD) at the sub-centre level so that data on TB patients screened for DM are reported to the NCD programme.

This bi-directional approach will be the first of its kind to be implemented at national level, with such initiatives recently being endorsed by the 66th World Health Assembly Resolution in May 2013.

Yield of diabetes high among TB patients
The current supplement on DM and TB concludes that the yield of diabetes was high among TB patients, while the yield of TB among DM patients was relatively low. The supplement consists of two review articles and eight operational research papers.

The first review article provides an up-to-date international perspective on the epidemiology of and interaction between DM and TB. The second review article looks at existing and new technologies for screening and diagnosing type 2 DM that may be more suitable for TB patients in low- and middle-income countries.

The eight operational research papers assess 1) bi-directional screening of the two diseases in one facility; 2) screening of DM patients for TB in one facility; and 3) screening of TB patients for DM in the other facilities.

WDF’s support to TB
TB-DM became a focus area for WDF in 2009. Since then 11 projects have been supported. 4% of WDF’s lifetime funding has been granted to TB-DM projects. In addition, the Foundation has provided funding for projects, documenting effective strategies and building effective health care capacity for screening and management of TB and diabetes which has encouraged the Government of India to recognise the dual burden and induced local policy changes in the area of “bidirectional” screening, where those diagnosed with TB would be screened for diabetes and vice versa at the national level.

Links to TB-DM resources
Open online access to the publication
Global TB Report (2013, WHO)
Collaborative Framework for Care and Control of Tuberculosis and Diabetes
Fact sheet on the co-epidemic