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:

• 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.

News Source: The Hindu