There is now good evidence of an important association between diabetes mellitus and tuberculosis, with diabetes increasing the risk of active tuberculosis by a factor of two to three and increasing the risk of adverse outcomes. Over the past 12 months, the World Health Organization and The Union have worked with international partners to develop a global framework for collaborative activities to reduce the dual burden of disease. This framework was given WHO Guideline Review Committee approval at the end of May 2011.
An important component of the proposed framework is to carry out bi-directional screening for active tuberculosis in patients with diabetes and for diabetes in patients with tuberculosis in order to make earlier diagnoses, which in turn may lead to better treatment outcomes and control of both diseases. How this screening is best done within routine health services is not known.
Over the next 18 months, the World Diabetes Foundation will support The Union to work with policy-makers and front-line staff in China and India to develop and implement screening procedures for both diseases. The first national stakeholders' meeting was held in Beijing on May 30-31 and attended by senior representatives from the China Ministry of Health, the Chinese Medical Association and the China CDC. They worked together to develop consensus over how to screen, how to monitor and how to report on outcomes and indicators on a quarterly basis. The meeting enabled The Union and those working at pilot hospitals and clinics to further develop the details, implementation and evaluation of screening procedures on the ground. The next step is for The Union to work with staff at 10 health facilities in July to brief and train them how to do the screening and how to do the quarterly recording and reporting in line with the DOTS approach.