Integrated health policies

· Diabetes and Tuberculosis (TB) Risk:

• Individuals with diabetes are 2-3 times more likely to contract TB than those without diabetes.
• TB in diabetics tends to present more severely, with higher TB scores, extensive lung cavitation, and prolonged periods to achieve negative smear or culture results.
• Poorly controlled diabetes can double the mortality risk during TB treatment and increase the bacterial load of Mycobacterium tuberculosis, potentially prolonging infectiousness.
• Screening for TB in diabetic patients may not be very effective outside of high-incidence areas.

· Management Challenges in Diabetes and TB:

• Drug interactions, particularly with rifampicin, complicate the management of diabetes in TB patients, necessitating dosage adjustments or alternative medications.
• Metformin is preferred for its safety profile and minimal interaction with rifampicin but carries risks like gastrointestinal side effects and lactic acidosis in those with impaired kidney function.
• Diabetic patients with active TB should avoid specialized diabetes services in early TB treatment to prevent the spread of TB, emphasizing the need for integrated care approaches.

· Global Health Policies and Diabetes Impact on TB:

• Stabilizing diabetes prevalence at 2015 levels in 13 high TB burden countries could significantly reduce TB incidence by 20.3% and mortality by 42.7% by 2035, potentially preventing 1.1 million TB deaths over 20 years.
• Integrated health policies are crucial, involving bidirectional screening for diabetes and TB at primary healthcare centers and adapting the DOTS framework for managing non-communicable diseases in resource-limited settings.

· Chronic Kidney Disease (CKD) and TB:

• Global increases in CKD prevalence have strengthened the link between CKD and TB infection.
• A study from 2008 to 2013 showed a higher incidence of TB in males with comorbidities such as heart failure, stroke, and diabetes, particularly from CKD stage 3 onwards.
• The risk of TB escalates with the progression of CKD, suggesting intensified TB prevention strategies for CKD patients from stage 3.

· RePORT-Brazil Study on TB and Diabetes:

• The "RePORT-Brazil" study involved individuals with culture-confirmed pulmonary tuberculosis and their close contacts.
• 62% of TB patients exhibited dysglycemia (prediabetes or diabetes), with diabetes significantly linked to a higher risk of transmitting M. tuberculosis to close contacts, underlining the complex relationship between metabolic disorders and TB management and transmission

References:

1. Amelia, G. and Suryanto, J., 2024. Sensitivity Analysis of Diabetes Mellitus and Tuberculosis for Confounders: A Comprehensive Systematic Review. The Indonesian Journal of General Medicine, 1(1), pp.28-45.
2. van Crevel, R.; Critchley, J.A. The Interaction of Diabetes and Tuberculosis: Translating Research to Policy and Practice. Trop. Med. Infect. Dis. 2021, 6, 8.
3. Shu, CC., Wei, YF., Yeh, YC. et al. The impact on incident tuberculosis by kidney function impairment status: analysis of severity relationship. Respir Res 21, 51 (2020).
4. Mangamba, L.M.E., Halle, M.P., Onana, C.L.M., Tochie, J.N., Ngamby, V., Noubibou, J.C.E., Balkissou, A.D., Tewaffeu, D.G., & Ngahane, B.H.M. (2023). Impact of Chronic Kidney Disease on the Mortality of Tuberculosis Patients: A Cross-Sectional Study in Douala. Health Sciences and Disease, 24(2).
5. Xiao, J., Ge, J., Zhang, D., Lin, X., Wang, X., Peng, L. and Chen, L., 2022. Clinical characteristics and outcomes in chronic kidney disease patients with tuberculosis in China: A retrospective cohort study. International Journal of General Medicine, 15, p.6661.
6. Carr, B.Z., Briganti, E.M., Musemburi, J., Jenkin, G.A. and Denholm, J.T., 2022. Effect of chronic kidney disease on all-cause mortality in tuberculosis disease: an Australian cohort study. BMC Infectious Diseases, 22(1), p.116.
7. Pan, S.C., Ku, C.C., Kao, D., Ezzati, M., Fang, C.T. and Lin, H.H., 2015. Effect of diabetes on tuberculosis control in 13 countries with high tuberculosis: a modelling study. The lancet Diabetes & endocrinology, 3(5), pp.323-330. See also: Lin TB Lab
8. Arriaga, M.B., Rocha, M.S., Nogueira, B.M., Nascimento, V., Araújo-Pereira, M., Souza, A.B., Andrade, A.M., Costa, A.G., Gomes-Silva, A., Silva, E.C. and Figueiredo, M.C., 2021. The effect of diabetes and prediabetes on Mycobacterium tuberculosis transmission to close contacts. The Journal of Infectious Diseases, 224(12), pp.2064-2072.

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