India’s diabetes epidemic is making its widespread TB problem worse
Context:
- Diabetes mellitus is a key risk factor that increases the incidence and severity of tuberculosis. Co-infections with tuberculosis also impair a patient’s ability to respond to therapy. Pre-diabetes was shown to be 24.5% prevalent while DM prevalence was revealed to be 25.3% among TB patients.
The dual responsibility:
- Type 2 diabetes (also known as diabetes mellitus, DM), tuberculosis (TB), and other horrible diseases were burdening India long before COVID-19 destroyed us.
- India currently has 74.2 million diabetics, and 2.6 million Indians get TB each year. Few people are aware of the connections between these ailments, though.
- There is no question that DM increases the risk of respiratory infections.
- DM is a substantial risk factor that increases the prevalence and severity of TB, as is also known.
- The way a patient responds to TB treatment is also negatively impacted by DM and TB co-infections.
- According to a 2012 study done at Chennai tuberculosis facilities, 25.3% of TB patients had diabetes mellitus, while 24.5% had pre-diabetes.
DM increases TB risk:
- In addition to increasing the chance of developing TB, DM slows the conversion of a person’s sputum smear and culture.
- Unchecked DM alters the cytokine response and the alveolar macrophages’ defence mechanisms, impairing cell-mediated immunity.
- Diabetes already compromises immune system performance, therefore TB infection is a major worry. They will also have a higher bacterial load.
- In people with TB and DM, lower lung area cavitary lesions are more prevalent.
- A 2016 study found that the TB-DM group had worse lung function after TB treatment than the TB non-DM group.
- DM also increases the likelihood of unfavourable outcomes from TB treatment, including treatment failure, relapse/reinfection, and even mortality.
- This demonstrates the significant impact of the twin burden of DM and TB, which affects patients’ families, the healthcare system, and communities. People who have DM and TB endure more acute suffering and have to struggle more to survive.
DM makes it difficult to cure TB:
- In someone with both conditions, lung function is severely reduced.
- People with DM and TB have also been observed to have chronic inflammation even after they have finished their TB therapy.
- Experts claim that individuals with TB and DM were more likely to die from respiratory issues related to TB than patients with simply TB.
- DM directly influences how these diseases impact those who have them. Poor TB treatment outcomes were more common in people with low body mass indices and low glycated haemoglobin levels, or HbA1c, as opposed to low BMI and high HbA1c.
- This shows that a person’s dietary status affects how well they respond to TB treatment.
- It also showed that the majority of deaths occurred due to respiratory issues (50%) and cardiovascular disease-related occurrences (32%), when comparing people with TB DM to those with TB only (TB only: 27% and 15%).
Suggestions:
- To begin with, we must provide integrated, patient-centered (i.e., more specialised) treatment to patients with TB, DM, and other comorbidities.
- The methods for coordinating TB and DM diagnosis and treatment, such as patient education and support, bidirectional TB and DM screening, and DM treatment in fresh TB cases, should be established based on the findings of studies.
- An essential part of this is enhancing the nutritional health of people with TB and DM since it can help increase the likelihood that TB therapy will be effective.
- It is imperative to focus enhancing particular programming for TB and DM as part of comprehensive treatment programmes, as well as to intensify high-quality care for TB, DM, and other related comorbidities.
- We need to build more robust, integrated health systems.
- More commitment from stakeholders, the establishment of stronger policy guidelines, and the mobilisation of extra resources are all necessary in order to support the growth of such systems.
- Furthermore, as better decision-making requires broader data availability, we must enlarge on the TB-DM study literature.
Moving forward:
- Health experts should prioritise studying the nature of interactions between the two diseases and creating effective response methods, both for the benefit of patients with both diseases and to raise public understanding of the impacts of their connected impact.
