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 Tuberculosis (TB), which killed an estimated 1.5 million people last
year according to the World Health Organization (WHO), is caused by
bacteria that lie dormant in many people.
However, diabetics TB become sick from latent TB infection far more
often than other people because their immune systems are compromised
-- a fact that could unleash an epidemic of co-infection as diabetes
rates soar along with growing obesity.
It is not the first time that the world has been confronted with
such co-infection. The HIV/AIDS pandemic, which destroyed the immune
systems of millions, lead to a quadrupling of TB rates in many
countries in Africa.
Now doctors fear a re-run of that scenario as diabetes takes hold
around the world, including in many poorer countries.
The big worry is that six of the top 10 countries projected to have
the greatest numbers of diabetics by 2035 -- China, India, Brazil,
Indonesia, Pakistan, and Russia -- are classified as high TB burden
countries by the WHO.
Anthony Harries of the International Union Against Tuberculosis and
Lung Disease told Reuters he was most concerned about India and
China, since India has the world's highest TB rate, followed by
China, while for diabetes China has the most cases, followed by
India.
"We want to raise an alarm that we don’t watch history repeat itself
with TB-diabetes,” he said.
Diabetes affected 382 million people in 2013 and will increase to a
projected 592 million by 2035, according to the International
Diabetes Federation.
Most of the cases will be of Type 2 diabetes, the kind that is
linked to obesity and is driven by the adoption of Western diets and
more sedentary lifestyles.
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"If we don’t act now to head this off, we’re going to experience a
co-epidemic of TB-diabetes that will impact millions and sap public
health systems of precious resources. The key is to prevent this
from happening,” Anil Kapur of the World Diabetes Foundation said.
While diabetes is not as great a co-infection threat as HIV, the
virus that causes AIDS raises the risk of TB by thirty fold, there
are about 10 times as many cases of diabetes in the world as people
living with HIV, so the overall impact is similar.
A joint report from Harries' and Kapur's groups presented at an
international lung conference in Barcelona sets out the case for
international action against the looming co-epidemic.
The report challenges the conventional approach of tackling
independently infectious diseases, like TB, and chronic
non-communicable diseases, like TB.
Fighting the threat will need a clear strategy of screening both
diabetes patients for TB and TB patients for diabetes, as well as
providing treatments for both diseases, the report says. Such
"bi-directional" screening is at present patchy.
(Editing by Louise Ireland)
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