Updated 14 December 2018

Growing TB-diabetes epidemic gets worldwide attention

Experts warn that the rising prevalence of diabetes will have a knock-on effect on the number of TB cases unless action is taken.

All South Africans with tuberculosis (TB) should be checked for diabetes and vice versa, advises a world TB expert.

People with diabetes are three times more likely to develop TB than those without TB, according to recent research.

'Bio-directional screening'

South Africa has the third-highest co-infection of TB and diabetes in the world after India and China, according to Dr Anthony Harries, Director of Research at the International Union against TB and Lung Disease.

Read: Diabetes fuels cases of TB

Speaking on the eve of the world’s first global conference on TB and diabetes, Harries said “bio-directional screening” for TB and diabetes was essential as many diabetics were unaware that they had TB, and TB patients were unaware of being diabetic.

About 75,000 South Africans living with diabetes develop TB annually, while around 300,000 Indians and 150,000 Russians suffered the same fate, said Harries.

One-third of the world’s population is living with latent TB. Like HIV, diabetes weakens a person’s immune system, giving the latent TB bacteria an opportunity to grow and become a full infection.

Read: Diabetes, TB and HIV/AIDS

“We have known about the association between TB and diabetes for about 40 years, but never really grasped the public health implications,” Harries said.

“Nobody has taken much notice about the link, perhaps because diabetes was seen to affect rich people in countries with no TB, and TB-affected poor countries.”

But thanks to lifestyle and dietary changes, diabetes is growing fast in developing countries, bringing the two epidemics together.

Averting a global health crisis

South Africans are the fattest people in Africa, and particularly at risk of developing diabetes, which is a common consequence of obesity.

Diabetics with TB also remain contagious for longer, don’t respond as well to TB treatment, are more likely to die of TB, and are much more likely to get TB again after successful treatment, according to Union research.

Read: 15 facts you need to know about tuberculosis

TB can temporarily increase blood sugar levels, which can push a pre-diabetic person into full diabetes.

Some TB drugs, especially rifampicin, interfere with the efficacy of oral diabetes medications.

This week the World Health Organisation (WHO) said TB was the world’s biggest killer among infectious diseases accounting for 1.4 million deaths in 2014.

This weekend, health officials, researchers, business and civil society advocates head to  Bali, Indonesia for the world’s first international summit on TB and diabetes in an effort to avert a global health crisis.

“Indonesia has a high burden of both TB and diabetes, and the WHO report strengthens our resolve to take action,” said Indonesian Minister of Health Dr Nila Moeloek.

Read: Prevalence of diabetes in South Africa

“We are hosting the first summit of public health leaders to urgently mobilise a global response to the double threat of TB-diabetes.”

“Today, 387 million people are affected by diabetes, with 77 percent of cases in low- and middle-income countries where TB is prevalent.

Diabetes is projected to affect 592 million people by 2035, which experts project will only fuel the global TB epidemic,” according to a joint press statement from the Union and the World Diabetes Foundation.

The Department of Health’s TB treatment guidelines recommend “optimising diabetes management during TB treatment”.

“The regular interaction with health care workers during TB treatment provides an excellent opportunity for health education and counselling for better diabetes control,” according to the health department. 

Read more: 

SA making progress in TB fight  

SA's TB rate among the highest in the world 

Smoker? Diabetes? Beware TB