Co-existence of diabetes and TB among adults in India: a study based on National Family Health Survey data

Abstract

Multiple studies suggest that diabetes mellitus (DM) is a potential risk factor for tuberculosis (TB) development and treatment, especially in low- and middle-income countries. The study aimed to test concomitancy between DM and TB among adults in India. Data were from the 2015–16 National Family Health Survey (NFHS-4). The study sample comprised 107,575 men aged 15–54 and 677,292 women aged 15–49 for which data on DM status were available in the survey. The association between state-level prevalence of TB and DM was examined and robust Poisson regression analysis applied to examine the effect of DM on TB. A high prevalence of TB was observed among individuals with diabetes in India in 2015–16. A total of 866 per 100,000 men and 405 per 100,000 women who self-reported having diabetes also had TB; among those who self-reported not having diabetes the ratios were 407 per 100,000 men and 241 per 100,000 women. The risk of having TB among those who self-reported having DM was higher for both men (2.03, 95% CI: 1.26, 3.28) and women (1.79, 95% CI: 1.48, 2.49) than for those who did not self-report having DM. Adults who were diagnosed with diabetes (including pre-diabetes) also had a higher rate of TB (477 per 100,000 men and 331 per 100,000 women) than those who were not diagnosed (410 per 100,000 men and 239 per 100,000 women). Adults from poor families, with lower BMIs, lower levels of literacy and who were not working had a higher risk of TB–DM co-morbidity. The state-level pattern of co-morbidity, the under-reporting of DM (undiagnosed) and TB stigmatization are discussed. The study confirms that diabetes is an important co-morbid feature with TB in India, and reinforces the need to raise awareness on screening for the co-existence of DM and TB with integrated health programmes for the two conditions.

Diabetes and tuberculosis syndemic in India: A narrative review of facts, gaps in care and challenges

“…On the contrary, among those who self‐reported not having DM the figures were 407 men and 241 women (per 100 000). Furthermore, these authors found that adults from poor families, with low body mass index, low levels of literacy, and who were unemployed had a higher risk of TB‐DM comorbidity 31 . It is not clear if mycobacterium TB mutates to cause more MDR‐TB in patients with diabetes.…”

“…Furthermore, these authors found that adults from poor families, with low body mass index, low levels of literacy, and who were unemployed had a higher risk of TB‐DM comorbidity. 31 It is not clear if mycobacterium TB mutates to cause more MDR‐TB in patients with diabetes. In a nested cohort ( n = 1633) studies of TB patients with and without DM in India, the authors found that phylogenetic reconstruction of all 76 paired Mtb strains showed genetically distinct isolates by participant origin, with 84% pairs acquiring at least one single‐nucleotide polymorphism (SNP) at treatment failure or recurrence.…”

Tuberculosis and Diabetes in India: Stakeholder Perspectives on Health System Challenges and Opportunities for Integrated Care

“…Enabling factors for bi-directional screening include availability of facilities at the screening center, sensitized and trained staff, adequate financial resources for the health care facility for doing bi-directional screening and a robust NCD program. Review of studies shows that TB patients registered at tertiary and secondary health centers were more likely to be screened than primary health centers probably due to better availability of laboratories, testing facilities, positive attitude, better sensitization and awareness among treating physicians and healthcare workers [ 29 , 30 ]. Studies also show that the bi-directional screening is highly acceptable in the community if the health system can mobilize required additional resources [ 31 ].…”

Challenges of Diabetes Management among TBDiabetes co-morbid Patients in Udupi District

“…TB-Diabetes co-morbid cases have been rising in the past few years in India. 7,8,9 Diabetes is responsible for impaired immunity which often increases the likelihood of getting TB infection. TB on the other hand, adversely affects glucose tolerance, thus elevating the risk ofdiabetes.…”