The global burden of diabetes mellitus (DM) is immense, with numbers expected to rise to over 550 million by 2030. Countries in Asia, such as India and China, will bear the brunt of this unfolding epidemic. Persons with DM have a significantly increased risk of developing active tuberculosis (TB) that is two to three times higher than in persons without DM. This article reviews the epidemiology and interactions of these two diseases, discusses how the World Health Organization and International Union Against Tuberculosis and Lung Disease developed and launched the Collaborative Framework for the care and control of TB and DM, and examines three important challenges for care. These relate to 1) bi-directional screening of the two diseases, 2) treatment of patients with dual disease, and 3) prevention of TB in persons with DM. For each area, the gaps in knowledge and the priority research areas are highlighted. Undiagnosed, inadequately treated and poorly controlled DM appears to be a much greater threat to TB prevention and control than previously realised, and the problem needs to be addressed. Prevention of DM through attention to unhealthy diets, sedentary lifestyles and childhood and adult obesity must be included in broad non-communicable disease prevention strategies. This collaborative framework provides a template for action, and the recommendations now need to be implemented and evaluated in the field to lay down a firm foundation for the scaling up of interventions that work and are effective in tackling this dual burden of disease.

SettingPrivate medical practitioners in Visakhapatnam district, Andhra Pradesh, India.ObjectivesTo evaluate self-reported TB diagnostic and treatment practices amongst private medical practitioners against benchmark practices articulated in the International Standards of Tuberculosis Care (ISTC), and factors associated with compliance with ISTC.DesignCross- sectional survey using semi-structured interviews.ResultsOf 296 randomly selected private practitioners, 201 (68%) were assessed for compliance to ISTC diagnostic and treatment standards in TB management. Only 11 (6%) followed a combination of 6 diagnostic standards together and only 1 followed a combination of all seven treatment standards together. There were 28 (14%) private practitioners who complied with a combination of three core ISTC (cough for tuberculosis suspects, sputum smear examination and use of standardized treatment). Higher ISTC compliance was associated with caring for more than 20 TB patients annually, prior sensitization to TB control guidelines, and practice of alternate systems of medicine.ConclusionFew private practitioners in Visakhapatnam, India reported TB diagnostic and treatment practices that met ISTC. Better engagement of the private sector is urgently required to improve TB management practices and to prevent diagnostic delay and drug resistance.

BackgroundThough internationally recommended, provider initiated HIV testing and counseling (PITC) of persons suspected of tuberculosis (TB) is not a policy in India; HIV seroprevalence among TB suspects has never been reported. The current policy of PITC for diagnosed TB cases may limit opportunities of early HIV diagnosis and treatment. We determined HIV seroprevalence among persons suspected of TB and assessed feasibility and effectiveness of PITC implementation at this earlier stage in the TB diagnostic pathway.MethodsAll adults examined for diagnostic sputum microscopy (TB suspects) in Vizianagaram district (population 2.5 million), in November-December 2010, were offered voluntary HIV counseling and testing (VCT) and assessed for TB diagnosis.ResultsOf 2918 eligible TB suspects, 2465(85%) consented to VCT. Among these, 246(10%) were HIV-positive. Of the 246, 84(34%) were newly diagnosed as HIV (HIV status not known previously). To detect a new case of HIV infection, the number needed to screen (NNS) was 26 among ‘TB suspects’, comparable to that among ‘TB patients’. Among suspects aged 25–54 years, not diagnosed as TB, the NNS was 17.ConclusionThe seroprevalence of HIV among ‘TB suspects’ was as high as that among ‘TB patients’. Implementation of PITC among TB suspects was feasible and effective, detecting a large number of new HIV cases with minimal additional workload on staff of HIV testing centre. HIV testing of TB suspects aged 25–54 years demonstrated higher yield for a given effort, and should be considered by policy makers at least in settings with high HIV prevalence.

Screening of DM patients for TB was feasible in a tertiary care hospital. The yield of new TB cases was low and merits further investigation. Socio-demographic and clinical characteristics were different in patients with DM and TB compared to those with DM only.

This pilot project shows that it is feasible and valuable to screen patients with TB for DM in a routine setting, resulting in earlier identification of DM and opportunities for better management of comorbidity.

BackgroundWith an estimated 65 million Diabetes Mellitus (DM) patients, India ranks second in the world in terms of DM burden. The emphasis of current medical practice has been on pharmacotherapy but, despite the best combination therapies, acheiving glycaemic control (reduction of blood sugar to desirable levels) is a challenge. ‘Integrated Naturopathy and Yoga’(INY) is an alternative system of medicine that lays emphasis on the role of diet and physical exercise. We assessed the short term effect of INY as an adjunct to pharmacotherapy on glycaemic control among type 2 DM patients.MethodsIn this prospective cohort study with a 3 month follow-up, DM patients consecutively admitted to a hospital in India from May-October 2014 for either 15 or 30 days were offered INY - a package of vegetarian diet with no added oil, sugar and salt, yoga-based exercise, patient counselling and rest. A ‘favourable outcome’ was defined as glycaemic control (glycosylated hemoglobin (HbA1c) < 7 % or absolute reduction by 1 %) along with at least 50 % reduction in antidiabetes medication at 3 months relative to baseline. Compliance to diet was scored by self-report on a scale of 0–10 and categorized into poor (0–5), moderate (6–8) and excellent (9–10).ResultsOf 101 patients with 3-month follow-up data, 65(65 %) achieved a favourable outcome – with 19(19 %) stopping medication while sustaining glycemic control. Factors associated with favourable outcome were baseline HbA1c and compliance to diet, which showed a significant linear relationship with mean HbA1c reductions of 0.4 %, 1.1 % and 1.7 % in relation to poor, moderate and excellent dietary compliance respectively.ConclusionINY, adjunctive to pharmacotherapy, was associated with a significant beneficial effect on glycaemic control and reduced the overall need for antidiabetes medications. These early results are promising. Further studies with long-term follow-up and using more rigorous randomized controlled trial designs are needed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12906-016-1264-0) contains supplementary material, which is available to authorized users.

Setting:Ten peripheral health institutions of a tribal t uberculosis unit, Saluru, Vizianagaram District, South India. Objective: To assess among tuberculosis (TB) patients: 1) the feasibility of screening for diabetes mellitus (DM), 2) the prevalence of DM, 3) the demographic and clinical features associated with DM, and 4) the number needed to screen (NNS) to find one new case of DM. Design: Cross-sectional study: all TB patients registered from January to September 2012 were screened for DM using a screening questionnaire and random blood glucose, followed by fasting blood glucose (FBG) measurements using a glucometer. DM was diagnosed if FBG was ⩾126 mg/dl. Results: Of 381 patients, 374 (98%) were assessed for DM, suggesting feasibility of screening, and 19 (5%) were found to have DM (12 were newly diagnosed and 7 had a previous diagnosis of DM). The only characteristic associated with DM was age ⩾40 years. The NNS to detect a new case of DM among all TB patients was 31; among those aged ⩾40 years, the NNS was 20, and among current smokers it was 21. Conclusion: Screening of TB patients for DM was feasible and effective, and this should inform national scaleup. Other key considerations include the continued provision of free TB-DM screening, with co-location and integration of services. showed that of 8109 TB patients who were assessed for DM, 1084 (13%) were found to have DM, based on fasting blood glucose (FBG) measurements. Based on these data, a policy decision was made by India's Revised National TB Control Programme (RNTCP) to implement countrywide screening of TB patients for DM. 11 One limitation of this study, however, was that it published only aggregate data from all sites, and may have missed site-specifi c variations, and other socio-demographic and clinical factors affecting the effectiveness and feasibility of the screening programme. AFFILIATIONSWe therefore analysed individual patient data and described the effectiveness of screening all TB patients for DM in one tribal TU. The tribal area is remote and diffi cult to access due to poor connectivity and lack of other basic infrastructure. Indicators relating to literacy, economic status, social status and access to health care services are poor among tribes compared to the general population. 12 The tribes are in transition from a forest-centred way of life to a rural, settled farming lifestyle. Given the different lifestyle, more access to unprocessed, fi brerich foods, including fruit and vegetables in their diet and greater daily physical activity, we hypothesized that the prevalence of DM would be considerably lower in tribal areas when compared with the rest of the country. The specifi c objectives of the study were to assess, among a cohort of TB patients: 1) the feasibility of screening for DM, 2) the prevalence of DM, 3) the demographic and clinical features associated with DM, and 4) the number needed to screen (NNS) to fi nd one new case of DM among TB patients. 13,14 METHODS Study designThis was a descriptive study of all TB patie...

BackgroundOver the last decade, the availability and use of mobile phones have grown exponentially globally and in Cambodia. In the Sihanouk Hospital Centre of Hope(SHCH) in Cambodia about half of all tuberculosis patients referred out to peripheral health facilities for TB treatment initiation or continuation were lost to contact after referral ranging from 19 to 69% between 2008 and 2013. To address this, we implemented a mobile phone-based patient tracking intervention. Here, we report the number and proportion of referred TB patients who could be contacted through a mobile phone and retained in care after the introduction of mobile phone tracking.MethodsA descriptive study involving follow-up of TB patients referred out from SHCH to peripheral health facilities during May–October 2014. Standard operating procedures were used to contact individual patients and/or health facilities using a mobile phone.ResultsAmong 109 TB patients referred to peripheral health facilities, 107(98%) had access to a mobile phone of whom, 103(97%) could be contacted directly while 5(2%) were contacted through their health care providers. A total of 108(99%) of 109 referred TB patients in intervention period were thus placed on TB treatment.ConclusionsThis study provides preliminary, but promising evidence that using mobile phones was accompanied with improved retention of referred TB patients compared to historical cohorts. Given the limitations associated with historical controls, we need better designed studies with larger sample size to strengthen the evidence before national scale-up.