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The Director's Corner

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World diabetes day: calling for action against the co-epidemic of TB and diabetes.

A message from José Luis Castro, Executive Director, The Union – November 2018 

In September we saw the United Nations convene High-Level Meetings on tuberculosis (TB) and non-communicable diseases (NCDs). I remember people’s concern that having both meetings back-to-back would dilute the meetings, yet the reality is that our leaders—as well as our researchers, physicians, community workers, advocates, in fact all of us–should not consider one illness in isolation.

One very alarming example of this urgent need to address the connections between diseases is the co-epidemic of TB and diabetes.

Diabetes is an underlying factor in 790,000 cases of tuberculosis (TB) each year, according to the World Health Organization’s (WHO) most recent Global Tuberculosis Report.

Diabetes weakens the immune system, making people more vulnerable to TB, meaning that people with diabetes are about three times more likely to develop TB. Diabetes also complicates people’s experience of TB. People living with diabetes who are sick with TB are more likely to die, and TB treatment is less likely to work unless diabetes is effectively managed.

According to the World Diabetes Atlas, the number of people living with type 2 diabetes worldwide is on course to increase from 425 million people today to 642 million by 2040. This massive rise in diabetes will generate more TB — especially because diabetes is increasing in countries where TB infection is common. By 2035, 80 percent of people living with diabetes will be in low- and middle-income countries.

A recent study showcased at the 49th Union World Conference on Lung Health showed that even people with elevated levels of glucose—typically considered “pre-diabetes”—are more vulnerable to TB as well. This means the number of people with TB who are facing complications is much larger than just those people with fully developed diabetes.

This is not just a disease of numbers. In a short documentary film, The Union explored the personal stories of two people in India living with TB-diabetes. Their stories show the impact on families, livelihoods, wellbeing – and the devastating waste of life. 

Governments and world leaders must act now, otherwise the co-epidemic between TB and diabetes will only get worse. Countries that will be most affected by diabetes—including China, India, Pakistan, the Russian Federation—are already countries where TB impacts large numbers of people.

The Political Declaration on the Fight Against Tuberculosis, endorsed by the UN General Assembly at the High-Level Meeting on TB, recognises diabetes as a major risk factor for TB and commits to helping people affected by both diseases. However, if they are to truly have an impact, these commitments must lead to action. There must be a coordinated approach globally, where countries act against both diseases in an integrated way.

One critical solution is providing two-way screening for TB and for diabetes, where people with TB should be routinely screened for diabetes and people with diabetes should be screened for TB in areas where TB is common—as piloted in a recent Union project in Uganda. For this to be the norm, we need closer collaboration between stakeholders working in infectious and non-communicable diseases.

If we fail to effectively tackle the links between TB and diabetes despite having the necessary scientific evidence and policy guidance, we may see the widespread needless suffering and preventable deaths witnessed with TB-HIV.

We know that we cannot fight TB in isolation; to end TB we must also fight the co-epidemics that cause the most harm.