DEADLY LINKAGES
This year, the World Health Organization (WHO) is marking its World Health Day (7 April), which celebrates the Organization’s founding in 1948, by issuing a call for action on diabetes. The number of people living with diabetes has almost quadrupled since 1980 to 422 million people, mainly in developing countries. At the same time, tuberculosis (TB) though decreasing in incidence, still affects 9.6 million people who fall ill each year and is a leading infectious disease cause of death alongside HIV/AIDS. In combination, TB and diabetes form a deadly blend.
The linkages between TB and diabetes have been recognized for decades. 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 tuberculosis. Diabetes triples a person’s risk of developing TB. About 15% of TB cases globally may be linked to diabetes. TB can temporarily cause impaired glucose tolerance which is a risk factor for developing diabetes. The likelihood that a person with TB will die or relapse is significantly higher if the person also has diabetes. Large proportions of people with diabetes as well as TB are not diagnosed, or are diagnosed too late. These linkages if not adequately addressed together will exacerbate both epidemics
NEED FOR INCREASED COLLABORATIVE ACTION
“In the era of the Sustainable Development Goals and with the new ambitious targets for health, there is no more excuse: working jointly to strengthen the bridges and streamline efforts between the TB and diabetes stakeholders and communities at all levels is mandatory if we have to end the TB epidemic by 2030 also through reduction of diabetes risk”, said Dr Mario Raviglione, Director, WHO Global TB Programme. “Together we can drive down both epidemics and save millions”.
Currently, there are strong global commitments to combat both these diseases. Ending TB by 2030 is a target of the new Sustainable Development Goals (SDGs) and the WHO End TB Strategy. Reducing premature death from noncommunicable diseases (NCDs), including diabetes, by 30% by 2030 is also a target of the SDGs and the WHO Global Action Plan for the Prevention and Control of NCDs. The WHO Strategies for both diseases incorporate elements of TB and diabetes collaborative activities.
In addition, since 2011, WHO and the International Union Against Tuberculosis and Lung Disease (the Union) have promoting use of a collaborative framework in countries, to guide national programmes, clinicians and others engaged in care and prevention of both diseases, on how to establish a coordinated response, at organizational and clinical levels. Read the Collaborative Framework for care and control of TB and Diabetes. This has already sparked actions on several fronts, including pilot projects, national policy dialogue, and new research.
“While efforts to address both diseases together have begun, there is still a long way to go”, said Dr Knut Lonnroth, Medical Officer, Policy, Strategy, Innovations Unit at the WHO Global TB Programme. “We need to further enable coordinated clinical management and address common health system bottlenecks and social determinants for both TB and diabetes. This is critical to save lives and ensure that all people with both disease have access to much-needed care.”
Collaborative framework for care and control of tuberculosis and diabetes