A World Health Organization (WHO) study from Kerala has sent out a
serious warning to the rest of India, which is home to over 60 million
diabetics. Nearly half of patients suffering from the deadly air-borne disease tuberculosis
(TB) in Kerala have been found to be diabetic, with approximately half of them
newly-diagnosed during the survey, showing the acute lack of awareness.
Among 552 TB patients screened, 243 (44%) had diabetes — 128 (23%)
previously-known diabetics and 115 (21%) newly-diagnosed — with higher
prevalence among males and those above 50 years. Of the 128 TB patients with
previously-known diabetes, 107 (84%) had HbA1c — more than 7% indicating poor
glycemic control.
Dr Anoop Misra, chairman Fortis Centre for Diabetes, Metabolic Diseases
and Endocrinology, said, "India should routinely start screening diabetics
for TB and TB patients for high blood sugar. It is important for countries like
India where numbers of both the diseases are enormous, with TB and diabetes
fuelling each other. It is important to look for both these diseases and
aggressively treat them."
The WHO in its World TB Report, 2012, said people with a weak immune
system, as a result of chronic diseases such as diabetes, are at a higher risk
of progressing from latent to active TB. One in three persons in the world is
infected with latent TB. People infected with latent TB have a life-long risk
of developing and falling sick with active TB.
According to WHO, people with diabetes have a two-three times higher
risk of TB compared to diabetics. About 10% of TB cases globally are linked to
diabetes. The global health watchdog has recommended that all TB patients
should be screened for diabetes. "Screening for TB in people with diabetes
should be considered, particularly in settings with high TB prevalence. People
with diabetes who are diagnosed with TB have a higher risk of death during TB
treatment and of TB relapse after treatment. WHO-recommended treatments should
be rigorously implemented for people with TB/diabetes. Diabetes is complicated
by the presence of infectious diseases, including TB," WHO said. "A
large proportion of people with diabetes as well as TB is not diagnosed, or is
diagnosed too late. Early detection can help improve care and control of
both," it added.
WHO has asked countries to set up a means of coordinating diabetes and
TB activities, conduct surveillance of TB disease prevalence among people with
diabetes in medium and high-TB burden settings, besides surveillance of
diabetes prevalence in TB patients in all countries. Countries have also been
asked to screen TB patients for diabetes and ensure high-quality diabetes
management among TB patients. The Kerala study says that while diabetes is a
known risk factor for TB, the prevalence among TB patients in India is unknown.
At present globally, more than 9 million people fall sick with TB every
year while over 1.5 million die from it. On the other hand, 350 million people
have diabetes with over 80% of diabetes deaths occurring in low and middle-income
countries. It is predicted that global diabetes prevalence will increase by 50%
by 2030.
Times of India
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