Study assesses diabetes as TB risk factor

Nearly half of a group of TB patients surveyed in Kerala had diabetes; and approximately half these patients were newly diagnosed. The new findings, which make a case for diabetes tests in all TB patients, were published in the October edition of PLoS One journal and were among the key poster presentations made at the 43rd Union World Conference on Lung Health in Kuala Lumpur.

This alarming presence of diabetes among TB patients in Kerala has now led to a pilot project for bi-directional screening at 120 sites in the country.

Of concern was the finding that the majority of the self-reported patients had poorly controlled diabetes. Nearly half (44 per cent) of the TB patients in Kerala were found to have diabetes mellitus, the highest reported prevalence of diabetes among TB patients to date. Further, 21 per cent were found to have previously-undiagnosed DM. This indicates that the strategy of routine screening of all TB patients for DM is likely to be cost-effective, said Shibu Balakrishnan, lead author of the study and WHO India's technical consultant to Kerala.

The study was conducted as a part of the 'TB Operations Research Training Project' within the Centre's Revised National Tuberculosis Programme.

While diabetes mellitus is a known risk factor with tuberculosis, the prevalence among TB patients in India is unknown. In 2010, approximately 25,000 patients were diagnosed with TB and treated through 73 TB reporting units statewide. So a statewide representative sample of TB patients in Kerala was interviewed and screened for DM in July last year. Of 552 TB patients screened, 243 had DM -128 were previously known to have DM while the remaining 115 were newly diagnosed, with a higher prevalence among males, Balakrishnan said.

Diabetes almost trebles the risk of developing tuberculosis. With India already facing a huge burden of TB, the country also has to deal with an epidemic growth in diabetes rates. The estimated prevalence of DM in India in 2010 was 51 million and this is projected to increase to 70 million by 2025. In India, 15 per cent of pulmonary tuberculosis cases have been estimated to be attributable to DM. An analysis of nutrition and DM changes in India also suggests that increased DM prevalence between 1998 and 2008 contributed to an increase in total TB cases at a rate this exceeded the population growth in the same period. These findings highlight the impact of the DM epidemic on TB incidence rates in the country, Balakrishnan said.

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