Paul Jensen, Senior Advisor (Policy) of the International Union Against Tuberculosis and Lung Disease (The Union) was on the panel of experts in a webinar for media on Lung Health Beyond 2015. He made these expert comments on TB and diabetes co-morbidity.
Original Title
Paul Jensen of The Union on TB and diabetes co-morbidity
Paul Jensen, Senior Advisor (Policy) of the International Union Against Tuberculosis and Lung Disease (The Union) was on the panel of experts in a webinar for media on Lung Health Beyond 2015. He made these expert comments on TB and diabetes co-morbidity.
Paul Jensen, Senior Advisor (Policy) of the International Union Against Tuberculosis and Lung Disease (The Union) was on the panel of experts in a webinar for media on Lung Health Beyond 2015. He made these expert comments on TB and diabetes co-morbidity.
Lung Disease (The Union) - Remarks on TB-Diabetes CNS Webinar July 2015 TB-diabetes is an example of a public health challenge that will become more serious unless action is taken now to prevent it. This is relevant for the post-2015 sustainable development goals, because the goals aim to end the TB epidemic by 2030. The TB epidemic will not be eliminated in the absence to a response to TB-diabetes. Until recently, TB-diabetes wasnt taken seriously because it was believed that in countries where TB is common, diabetes is not; and in countries where diabetes is common, TB is not. But this is not true. According to researchers, its estimated that more than 80 percent of diabetes-related deaths happen in low and middle income countries not in high income countries as previously believed. 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. Now, this is important for TB, because people with diabetes are two to three times more likely to develop TB than people who do not have diabetes. (The underlying causes for this are not even known yet because there hasnt been enough research - but it has something to do with the fact that diabetes has the potential to weaken the immune system.) Whats more is that people with diabetes have worse TB treatment outcomes. People with diabetes who also have TB are more likely to die from TB compared to people who dont have diabetes. And theyre more likely to get TB again in the future. What this means is that right now, its estimated that 15 percent of all people with TB worldwide also have diabetes. This comes out to be 1,042,000 adults who have TB and who are also living with diabetes. This is only slightly less than the number of people with TB who are living with HIV infection. Whats more is that diabetes is increasing globally. Its predicted that
diabetes prevalence the number of people who are living with
diabetes is going to increase by 50 percent by 2030. And these increases are happening primarily in low and middle income countries. Implications: 1. Its common that for people who have diabetes and TB, theyre forced to receive care at different clinics. The health workers who treat TB are different from the health workers who treat diabetes, and they dont really talk to each other. 2. A lot of global resources and political attention have gone into TB in the last 10-20 years. Not enough, but more than in the past. If we ignore diabetes and dont stop its impact, then it could start to eliminate the progress made against TB in countries where TB is common. Lessons from History: TB-HIV. For years, the public health community knew that HIV was a major risk factor for TB and that TB-HIV was killing large numbers of people. WHO issued a policy framework for addressing TB-HIV through collaborative activities. But the implementation of these policies at the country level was slow and took years to scale up. The result was large numbers of avoidable deaths. We do not want to repeat this history when it comes to TB-diabetes. WHO/Union recommendations All people with TB 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. It is important that proper care for diabetes is provided to those that are suffering from TB/diabetes This sounds simple but Lessons for the post-2015 development agenda: Addressing TB and diabetes in an integrated way will challenge health systems - in part because the conventional approach is for infectious diseases and chronic illnesses to be seen as two different types of
health challenges. There isnt much interaction between infectious
disease experts and NCD experts - inside of countries or internationally. So part of the challenge will be to break down barriers and to open communication among different groups of public health experts. Coordinated planning and service delivery across communicable and non-communicable disease programs is now necessary. This is something that needs to happen at different levels of the health system - national level, perhaps district level, city level for urban areas. Investments in human resources health workers are going to be important for being able to deliver integrated care for both TB and diabetes. One simple, inexpensive, and as yet unevaluated method is to implement a major education programme for care givers and patients, so that persons with diabetes understand the risks of TB, recognise the symptoms and present to health care services when they think they might have TB. Such an approach might also help mitigate the risk of person-to-person TB transmission within DM clinics.
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