Diabetes and Tuberculosis: India’s Dual Health Crisis - Dr Padma Sundaram

India, a country grappling with a myriad of public health challenges, finds itself at the crossroads of two major epidemics: diabetes and tuberculosis (TB). The convergence of these two diseases poses a formidable challenge to public health efforts in the nation. Here's a closer look at the intertwining issues and the efforts underway to confront them.

High Prevalence

India bears a staggering burden of both diabetes and TB. Studies reveal that approximately 20% of TB patients in India also suffer from diabetes, compounding the challenges of treating both conditions simultaneously.

Risk Factors and Challenges

Several factors contribute to the complexity of addressing the intersection of diabetes and TB in India. Diabetes, known to weaken the immune system, predisposes individuals to heightened susceptibility to TB infection.

Moreover, under-diagnosis of diabetes, particularly in its early stages, poses a significant barrier to timely intervention for both diseases. Additionally, the fragmented nature of the healthcare system impedes efforts to integrate TB and diabetes care, resulting in disjointed treatment approaches.

Worsened Outcomes

The coexistence of diabetes and TB significantly complicates treatment outcomes. Diabetic patients diagnosed with TB are confronted with heightened risks, including treatment failure, relapse, and increased mortality rates. Moreover, the management of blood sugar levels becomes increasingly challenging due to the interactions between TB medications and diabetes treatment protocols.

Diabetes and Tuberculosis

People with diabetes (DM) and tuberculosis (TB) require special attention. For patients with DM, a low threshold for TB testing is recommended upon signs or symptoms.

While treatment is similar for TB itself, close monitoring is crucial due to increased risk of treatment failure in diabetics. To prevent TB spread in clinics, those with both conditions should be treated in the TB clinic initially, minimizing visits to the DM clinic.

Metformin is the preferred medication for diabetes control, with insulin as an alternative. For those with cardiovascular disease, aspirin and statins are recommended.

Additionally, both patients and healthcare providers need education on managing weight, diet, exercise, and smoking cessation. Collaborative efforts are vital to address this dual diagnosis. This includes national plans for joint TB-DM activities, resource allocation, training, and public awareness.

Screening is also important. All TB patients, particularly those over 40, should be tested for diabetes (fasting blood glucose or HbA1c preferred). In high TB burden areas, diabetics should be actively screened for TB using symptom checks and Xpert MTB/RIF tests. Chest X-rays may also be used with further investigation based on results.

Looking Ahead

Despite the formidable challenges, concerted efforts are underway to confront the dual threat of diabetes and TB in India. Collaborative initiatives between TB and diabetes control programs aim to enhance coordination and facilitate data sharing for more effective disease management.

Furthermore, efforts are being made to equip healthcare workers with the necessary training and resources to provide comprehensive care to patients afflicted with both conditions. Additionally, ongoing research endeavors seek to elucidate the full extent of diabetes's impact on TB outcomes within the Indian context.

India's battle against TB necessitates a concerted focus on identifying and managing diabetes in co-infected patients. By fostering collaboration, raising awareness, and implementing integrated approaches to care, the nation can strive towards improving treatment outcomes and ultimately saving lives in the face of this double threat.