The associated link between tuberculosis (TB) and diabetes is a matter of growing concern for China, which not only has one of the highest burdens of TB in the world but is also witnessing one of the fastest increases in diabetes prevalence.China accounts for almost 17% of the world's TB burden with an estimated 1.5 million new cases and around 270,000 deaths each year. Added to this is an increasing incidence of multidrug-resistant TB, particularly in areas where directly observed treatment (DOTS) is unavailable.Likewise, the prevalence of diabetes has been increasing in recent years and around 40 million people in China are estimated to have diabetes. Unfortunately, the level of awareness, treatment and control is quite low, which significantly increases the risk of severe complications and pre-mature deaths.The objective of this project is to investigate the association between tuberculosis (TB) and diabetes in the People's Republic of China to improve the treatment of patients with both diseases.
This project is headed by the School of Public Health at the Medical College of Qingdao University. The School of Public Health will collaborate closely with the local centres for disease control (CDCs) and community health centres to ensure successful implementation of the project.Although the prevalence rates of TB and diabetes in China are high, little is known about the association between the two diseases in the country. As diabetes may impair the response to TB treatment, it is very important to assess to what extent the two diseases are simultaneously present in Chinese TB patients in order to ensure their proper management.The project will be implemented in 19 counties of two provinces of China, namely Gansu in the northwest and Shandong in the northeast. Gansu is widely considered to be one of the poorest provinces in China.At the start of the project, training of health personnel working with TB in the two provinces will be undertaken. The health care workers will be trained in detection of diabetes and regular management of the disease. A total of 400 health care workers will be trained.The trained health care workers will then screen 7,000 TB patients in the area for diabetes. In order to be able to assess if the prevalence of diabetes is elevated among the TB patients, 7,000 people without diabetes of similar age and sex will be selected from the same communities and screened for diabetes. They will also be screened for TB to ensure that they do not have TB. In addition to the detection of TB and diabetes, the health care workers will also obtain information about socio-economic status, diet, level of physical activity and environmental factors.People found to have diabetes or TB will be offered appropriate treatment and referrals. Furthermore, in coordination with the local CDCs and health centres, the patients will be provided health information to ensure compliance with both TB and diabetes treatment. This will not only improve the outcome of the diseases e.g. by reducing the risk of diabetes-related complications; it will also reduce the risk of multidrug-resistant TB.Based on the results of the screening and project experience, protocols and guidelines on treatment for patients with both TB and diabetes will be developed and distributed to health centres.Finally, awareness of diabetes and the link between TB and diabetes will be raised among the general public and health professionals through the dissemination of various education materials including booklets and posters. It is expected that these activities will reach out to around 1 million people.
• 390 TB health care workers and 2,000 village nurses trained in diabetes diagnosis and management • 11,523 TB patients (6,638 in Shandong, 4,885 in Gansu) • 10,525 people who do not have TB (7,369 in Shandong and 3,129 in Gansu) screened for diabetes • 552 TB+DM patients, 11,523 TB patients and nearly 1 million lay public have been reached with awareness messages and health promotion.• A treatment protocol (suggested) for people with TB and DM has been developed.