Burgeoning double burden of tuberculosis and diabetes in India: Magnitude of the problem - Strategies and solutions

Background: India reportedly has a fifth of tuberculosis burden worldwide. There is a strong epidemiological evidence for an association between tuberculosis and diabetes mellitus (DM). Patients with diabetes are at increased risk of developing active TB, and have higher rates of treatment failure and death, even when placed on appropriate therapy. Objective: We sought to perform a comprehensive review of the convergence of these two epidemics in India and strategies for co-management. Methods: We performed a literature search of current knowledge including observational studies and clinical trials and other position papers, from databases such as, Medline, Embase, worldwide web and other repository of WHO and other international and national reports with the following search terms: tuberculosis, diabetes mellitus, co-epidemics, India, management and strategies. Results: Combined results from several cohort studies suggest that DM increases the risk of active TB by approximately three fold. This association between TB and DM will become more poignant in the coming years, as the prevalence of diabetes is expected to increase substantially in the developing nations. We describe the epidemiology of each disease in detail, and its convergence. We also discuss the challenges in co-management of TB and DM, including the role of nutrition. The article investigates the barriers, gaps in research data and opportunities to tackle this problem at the policy and grass roots level. The newly evinced approach of public private partnerships with market based partnerships for health (MBPH) need to be explored. Conclusions: Treatment of diabetes as a co-disease presents an opportunity for collaboration with the current TB control efforts to be expanded. Considering the existing public health infrastructure and the overarching private sectors' role in the co-management, standard treatment guidelines which incorporate the core issues in the bi-directional screening and cost-effective management of TB and diabetes need to be developed and enforced. Copyright (C) 2013, INDIACLEN. Publishing Services by Reed Elsevier India Pvt Ltd. All rights reserved.