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Thursday, December 14, 2017

New insights in diabetes, TB infection

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The world’s largest annual conference on lung health in Mexico has put forward new insights in the much-talked about interactions between diabetes and tuberculosis.

A study presented on the opening day of the four-day conference in the city of Guadalajara on Wednesday showed that people with poorly controlled diabetes have a higher risk for “latent tuberculosis”.

This is the first-ever population based study after the interactions between diabetes and tuberculosis or TB came as a wake-up call in 2014.

Since then, researchers have been calling upon the governments to start ‘bi-directional screening’ for the simultaneous detection of TB and diabetes, a method that screens TB patients for diabetes and diabetes patients for TB.

Diabetes upsets immunity, and triples a person’s risk of contracting TB. On the other hand, unchecked diabetes compromises lengthy TB treatment outcomes.

Leonardo Martinez, postdoctoral research fellow of Stanford University School of Medicine USA, said they had carried out the population-based study of some 4000 individuals in the United States. They tested for TB infection and several biomarker tests for diabetes.

This included 776 diabetics, 1441 pre-diabetics, and 1998 non-diabetic individuals.

The study shows that diabetics had higher rates of TB infection than non-diabetic individuals. It also showed that diabetics with markers of poor diabetic or glycemic control were more likely to have TB infection.

For example, undiagnosed diabetics, who often have uncontrolled diabetes, had 12 percent prevalence of TB infection - a rate 3-4 times higher than the general population.

Diabetics with high levels of fasting plasma glucose, a biomarker of poor sugar control also had significantly higher rates of TB infection.

 “The study concludes that that poorly controlled diabetes presents a higher risk for latent TB and that this may be a group to target for latent TB testing and consideration of latent TB therapy,” Martinez said at the opening press briefing of the conference.
He, however, suggested further studies in a high tuberculosis burden country like India. This gives a new insight linking diabetes with latent tuberculosis infection.

If the two co-exist then it compromises the tuberculosis treatment outcome. So, globally it is recommended that a TB patient must know his or her diabetic condition particularly in a country like Bangladesh where it is widespread, and vice versa.

In the ‘bi-directional screening’, hospitals will ask TB patients whether they have diabetes and if the answer is negative, then they will be screened with a blood test for glucose.

And a diabetes patient will be asked about the key TB symptoms such as persistent cough, weight loss, fever, and sweating and, if the answer is yes, investigations will be carried out for TB.

About 3,000 TB professionals from around the world have gathered in Guadalajara for the conference, where over 800 scientific abstracts addressing every aspect of TB advocacy and research would be presented.

With the theme, 'Accelerating Toward Elimination', the conference features studies that shine a light on scientific innovation, technologies that have the potential to transform TB diagnosis and treatment, ongoing work around active case finding and efficacy studies around new drugs.

“We’ve known for some time now that if we are to eliminate TB by 2030, we are going to need new scientific tools that enhance our capacity to reach, diagnose and treat people living with TB,” said José Luis Castro, Executive Director of The Union.

“This year´s conference is living proof that renewed scientific progress has taken off which is encouraging but, at the same time, that needs to be matched by a political commitment from governments to invest in research and development so that research momentum is maintained.”

TB is now the world’s leading cause of death from an infectious disease with 1.8 million deaths annually, having surpassed HIV/AIDS in 2015. Drug-resistant forms of the disease become a new challenge.

Over 10 million people per year contract the disease and TB is now among the top ten global killers.

Ending the TB epidemic by 2030 is one of the health targets of the newly adopted UN's Sustainable Development Goals or SDGs.

WHO ranks Bangladesh as one of the 22 ‘high TB-burden’ countries. The UN agency says Bangladesh has high rates of migration and the transient population faces poverty, overcrowding and poorly ventilated living and working conditions, all of which allow TB to spread.

The conference will also shine a light on the political momentum gathering ahead of next year´s inaugural United Nations General Assembly High-Level Meeting on TB.

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