Diabetes Mellitus (DM) and Tuberculosis (TB)

Context:

For a very long time, India has been experiencing the burden of two severe Epidemics, Diabetes Mellitus (DM) and Tuberculosis (TB), however few know how deeply these diseases are interlinked.

Relevance:

GS II: Health

Dimensions of the Article:

1. Interlink between Diabetes Mellitus (DM) and Tuberculosis (TB)
2. What can be done to Tackle Both DM and TB?
3. Diabetes Mellitus (DM)
4. Tuberculosis

Interlink between Diabetes Mellitus (DM) and Tuberculosis (TB):

The presence of Diabetes Mellitus (DM) increases the risk of developing respiratory infections, and it is a major risk factor that affects the incidence and severity of Tuberculosis (TB).

Here are the key points highlighting the interlink between DM and TB:

Prevalence and Impact:

• Studies have shown a high prevalence of DM among individuals with TB. In one study conducted in Chennai, 25.3% of TB patients had DM, while 24.5% were found to be pre-diabetic.
• DM not only increases the risk of contracting TB but also impairs the recovery process and prolongs the time required for TB bacteria to be eliminated from the body.

Effect on Immunity:

• DM compromises the body’s cell-mediated immunity, which hampers its ability to fight infections, including TB.
• The weakened immune response in DM individuals makes them more susceptible to TB infection.

Altered Lung Environment:

• Uncontrolled DM affects the defense mechanisms in the lungs, creating an environment that promotes the invasion and establishment of TB bacteria.
• DM-induced changes in small blood vessels in the lungs and poor nutritional status further contribute to the favorable conditions for TB infection.

Treatment Outcomes:

• DM increases the likelihood of unfavorable treatment outcomes for TB, including treatment failure, relapse/reinfection, and even death.
• The coexistence of TB and DM can modify TB symptoms, radiological findings, treatment approaches, and final outcomes.

Impact on Health and Healthcare:

• The dual burden of DM and TB not only affects the health and survival of individuals but also poses a significant burden on healthcare systems, families, and communities.

What can be done to Tackle Both DM and TB?

To tackle both Diabetes Mellitus (DM) and Tuberculosis (TB), several measures can be taken. Here are key strategies to address these conditions comprehensively:

Integrated Care:

• Provide individualized care for patients with both DM and TB, ensuring that treatments for both conditions are integrated and coordinated.
• Foster collaboration and communication between healthcare providers managing DM and TB to optimize patient outcomes.

Patient Education and Support:

• Improve patient education on the importance of adherence to medication, regular monitoring, and healthy lifestyle practices for managing DM and TB.
• Provide counseling and support services to enhance patient motivation, engagement, and treatment adherence.
• Promote proper nutrition and address any nutritional deficiencies to support optimal response to TB treatment.

Strengthened Healthcare Programs:

• Strengthen healthcare programs for both DM and TB, including prevention, screening, diagnosis, and treatment services.
• Build resilient and integrated health systems that can effectively manage and provide comprehensive care for individuals with both conditions.
• Enhance collaboration between DM and TB programs, sharing data and best practices to improve outcomes and resource allocation.

Research and Evidence-Based Decision-Making:

• Invest in research to generate evidence on the best approaches for managing DM and TB in coexisting cases.
• Use research findings to inform evidence-based decision-making, policy development, and program implementation.
• Promote innovation and the development of new tools, technologies, and strategies for prevention, diagnosis, and treatment of DM and TB.

Community Engagement and Partnerships:

• Engage communities and raise awareness about the link between DM and TB, emphasizing prevention, early detection, and timely treatment.
• Foster partnerships between healthcare providers, policymakers, civil society organizations, and community leaders to address the dual burden of DM and TB effectively.

Diabetes Mellitus (DM)

• DM is a metabolic disorder characterized by high blood sugar levels due to insufficient insulin production or ineffective insulin utilization.
• The term Diabetes Mellitus is used to differentiate it from Diabetes Insipidus, a rare condition unrelated to blood glucose levels.
• Diabetes Insipidus also causes excessive urination, but it does not impact blood glucose levels.

Blood Glucose Levels and Classification

• Fasting blood glucose levels of 70–110 mg/dL are considered normal.
• Blood glucose levels between 100 and 125 mg/dL indicate prediabetes.
• A level of 126 mg/dL or higher signifies diabetes.

Types of Diabetes

Type 1 Diabetes

• In Type 1 Diabetes, the immune system attacks and destroys the insulin-producing cells in the pancreas.
• As a result, the pancreas produces little or no insulin.
• Only 5 to 10% of people with diabetes have Type 1.
• It typically develops before the age of 30 but can occur later in life.

 Type 2 Diabetes

• Type 2 Diabetes involves a combination of insulin resistance and inadequate insulin production.
• The pancreas initially compensates by producing extra insulin, but over time, insulin production declines.
• Type 2 Diabetes was previously uncommon in children but has become more prevalent.
• It primarily affects individuals over the age of 30 and is more common with increasing age.
• Approximately 26% of people aged 65 and older have Type 2 Diabetes.

Tuberculosis

• TB remains the world’s deadliest infectious killer.
• Each day, over 4000 people lose their lives to TB and close to 30,000 people fall ill with this preventable and curable disease
• TB is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs.
• Transmission: TB is spread from person to person through the air. When people with TB cough, sneeze or spit, they propel the TB germs into the air.
• Symptoms: Cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats.
• Treatment: TB is a treatable and curable disease. It is treated with a standard 6 month course of 4 antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteer.
• Anti-TB medicines have been used for decades and strains that are resistant to 1 or more of the medicines have been documented in every country surveyed.
• Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to isoniazid and rifampicin, the 2 most powerful, first-line anti-TB drugs. MDR-TB is treatable and curable by using second-line drugs.
• Extensively drug-resistant TB (XDR-TB) is a more serious form of MDR-TB caused by bacteria that do not respond to the most effective second-line anti-TB drugs, often leaving patients without any further treatment options

-Source: The Hindu