Diabetes Mellitus (DM) and Tuberculosis (TB) in India

Context:  India has been experiencing the double burden of two debilitating and severe epidemics – type 2 diabetes (a.k.a. diabetes mellitus, DM) and tuberculosis (TB). The figures for both are staggering. Current Status:

• India has around 74.2 million people living with diabetes while TB affects 2.6 million Indians every year.

Link between DM and TB:

Relationship	Description
DM and Respiratory Infections	DM increases the risk of developing respiratory infections.
DM as a Risk Factor for TB	DM is a major risk factor that increases the incidence and severity of TB.
DM and TB Co-Infections	DM and TB co-infections have an adverse effect on TB treatment outcomes in patients.
Prevalence of DM and Pre-Diabetes in TB Patients	In a 2012 study conducted in tuberculosis units in Chennai, it was found that among people with TB. The prevalence of DM was 25.3%. 24.5% of individuals were pre-diabetic.

• Delayed Conversion: DM delays the sputum smear and culture conversion in individuals with both DM and TB, meaning it takes longer for TB bacteria to decrease below the threshold for claiming healing.
• Impaired Immunity: DM impairs cell-mediated immunity and affects cytokine response, compromising immune function and increasing the risk of TB infection.
• Altered Defences: DM alters defences in alveolar macrophages and small blood vessels in the lungs, facilitating TB invasion and establishment.
• Higher Bacterial Load: People with DM and TB have a higher bacterial load, leading to more severe symptoms.
• Radiological Findings: Individuals with TB and DM are more likely to have cavitary lesions in lower lung fields.
• Lung Function: TB-DM patients show reduced lung functioning after TB treatment compared to TB non-DM patients.
• Treatment Outcomes: DM increases the likelihood of unfavorable TB treatment outcomes, such as treatment failure, relapse/reinfection, and death.
• Impact: The coexistence of DM and TB has a greater impact on patients, healthcare systems, families, and communities.

Way Forward:

• Integrated and Patient-Centred Care: Implement integrated care approaches that cater to the individual needs of patients with TB and DM, as well as other comorbidities.
  • Establish coordinated mechanisms for the diagnosis and treatment of both TB and DM, including bidirectional screening, patient education and support, and DM treatment in new TB cases.
• High-Quality Care for Comorbidities: Intensify high-quality care for TB, DM, and associated comorbidities by incorporating them into holistic treatment plans.
• Building Resilient and Integrated Health Systems: Increase commitment from stakeholders to build and scale up resilient and integrated health systems that effectively address TB, DM, and other related conditions.
  • Develop stronger policy guidance and mobilize additional resources to support the development of integrated healthcare systems.
• Enhancing Research and Data: Build on the existing TB-DM research literature to gain a deeper understanding of the interactions between these two diseases.
  • Promote research that explores the nature of their interactions and develops appropriate response strategies.
  • Access to better data will enable informed decision-making and improve patient outcomes.

Additional Information: About Type 2 Diabetes: Type 2 diabetes affects how the body uses sugar (glucose) for energy. It stops the body from using insulin properly, which can lead to high levels of blood sugar if not treated. Over time, type 2 diabetes can cause serious damage to the body, especially nerves and blood vessels. About TB: TB is caused by a bacterium called Mycobacterium tuberculosis, belonging to the Mycobacteriaceae family consisting of about 200 members. India’s Initiatives to Eliminate TB: Under the Pradhan Mantri TB Mukt Bharat Abhiyan, India aims to eliminate TB from the country by 2025 (5 years earlier than the global target of 2030).

 News Source: The Hindu