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

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