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Preventing TB in people with diabetes: where are we now and where are we going?

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To mark World Diabetes Day, 14 November, Professor Anthony Harries, Senior Adviser at The Union writes about the changing landscape and progress on tuberculosis (TB) and diabetes:

Back in November 2009, The Union hosted an expert meeting with the World Health Organization (WHO) and the World Diabetes Foundation on TB and diabetes mellitus, which concluded that diabetes increases the risk of TB by almost three-fold, and by outlining the best ways forward for drawing up guidelines and addressing research gaps.

One of the areas identified for research at that time was TB preventive therapy in people with diabetes, although it was given low priority. In the intervening 11 years the landscape has changed. The WHO End TB Strategy now promotes preventive therapy of people at high-risk of TB and the United Nations High-Level Meeting on Tuberculosis in 2018 committed world leaders to provide TB preventive therapy to at least 30 million people between 2018 and 2022.

The high-risk priority groups are people living with HIV and household / close contacts of patients with TB. Yet despite people with diabetes being at higher risk of TB, they are currently not prioritised for systematic screening of TB infection nor TB preventive therapy. There is insufficient evidence, so the argument goes.

In October 2020, the 51st Union World Conference on Lung Health was held virtually for the time, meeting under the theme Advancing Prevention. A symposium (SP23) entitled “Preventing TB in people with diabetes: where are we now and where are we going?” was organised by Professor Lin Yan from The Union Office in China, with five presentations addressing TB preventive therapy in people with diabetes.

Professor Jann-Yuan Wang showed preliminary data from Taiwan on whether different TB preventive therapy regimens in those with poorly controlled diabetes could reduce TB infection. The results were encouraging.

Dr Leo Martinez used data from a large systematic review and meta-analysis to show that TB preventive therapy in adults with diabetes was 84 percent protective against progression from infection to active TB disease.

Professor Reinout van Crevel presented the outline of a European Union EDCTP randomised controlled trial in Uganda and Tanzania called PROTID – Prevention of Tuberculosis in Diabetes. This trial started in January 2020 and will examine a wide range of issues including efficacy and safety of different preventive therapy regimens, who to target and how best to screen for TB infection and active TB disease.

We are in an exciting time for TB and diabetes mellitus, as the global health community embraces the intensified research and innovation set out in the WHO End TB Strategy, which in turn should enable better evidence-based management of people with diabetes and TB.


Registered delegates of the 51st Union World Conference on Lung Health can watch the symposium SP23 “Preventing TB in people with diabetes: where are we now and where are we going” until 30 November.

Alternatively, become a member of The Union here, to access this and all other content from this year’s Union World Conference.