Effect of diabetes on tuberculosis control in 13 countries with high tuberculosis: a modelling study

Pan, Sung‐Ching; Ku, Chu-Chang; Kao, Diana; Ezzati, Majid; Fang, Chi-Tai; Lin, Hsien Ho

doi:10.1016/s2213-8587(15)00042-x

Cited by 75 publications

(63 citation statements)

References 22 publications

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“…Diabetes is also a risk factor for tuberculosis, another disease with large burden in low-income and middle-income countries 54 . Diabetes and its complications impose substantial economic costs on patients, their families, health systems, and national economies because of direct costs of treatment and loss of work and wages 2 .…”

Section: Discussionmentioning

confidence: 99%

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants

Zeng¹,

Lu²,

et al. 2016

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SummaryBackgroundOne of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes.MethodsWe pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence—defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs—in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue.FindingsWe used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for. Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4–7·0) in 1980 to 9·0% (7·2–11·1) in 2014 in men, and from 5·0% (2·9–7·9) to 7·9% (6·4–9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target.InterpretationSince 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults affected, has increased faster in low-income and middle-income countries than in high-income countries.FundingWellcome Trust.

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Section: Discussionmentioning

confidence: 99%

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants

Zeng¹,

Lu²,

et al. 2016

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“…Therefore, even though DM confers a significantly lower risk of TB at the individual level (3-fold) when compared to HIV (>20-fold), in communities like these where the sheer number of DM patients is high, the contribution of DM to TB can be higher than HIV (25). A study using dynamic TB transmission models to analyze the potential effects of DM on TB epidemiology in 13 countries with high burden of TB concluded that stopping the rise of DM would avoid 6 million (95% CI 5.1, 6.9) incident cases and 1.1 millin (1.0, 1.3) TB deaths in these countries in 20 years (26). Thus, every community worldwide needs to evaluate the prevalence of DM and its contribution to TB.…”

Section: Epidemiology Of Tb-dmmentioning

confidence: 99%

Diabetes and Tuberculosis

2016

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The increase in type 2 diabetes mellitus (DM) patients in countries where tuberculosis (TB) is also endemic has led to the reemerging importance of DM as a risk factor for TB. DM causes a 3-fold increase in TB risk and a 2-fold increase in adverse TB treatment outcomes. Given the sheer numbers of DM patients worldwide, there are now more TB patients with TB-DM comorbidity than TB-HIV coinfection. There is an urgent need to implement strategies for TB prevention and control among the millions of DM patients exposed to Mycobacterium tuberculosis . This chapter summarizes the current epidemiological, clinical, and immunological knowledge on TB and DM and their clinical and public health implications. These include the underlying mechanisms for TB risk in DM patients and their clinical and sociodemographic characteristics that distinguish them from TB patients without DM. TB-DM comorbidity is posing a new challenge for integrating the short-term care for TB with the long-term care for DM, particularly in low- and middle-income countries.

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“…According to the World Health Organization (WHO), the world is on track to meet the target of a 50% mortality reduction of tuberculosis (TB) [1], but new challenges such as diabetes are challenging this progress [2]. With 6% of TB cases worldwide attributable to diabetes [3], there is the need to bridge the management of diabetes and TB from a health system perspective [4].…”

Section: Introductionmentioning

confidence: 99%

Addressing the double-burden of diabetes and tuberculosis: lessons from Kyrgyzstan

Skordis‐Worrall¹,

Round

Arnold³

et al. 2017

Global Health

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BackgroundThe incidence of diabetes and tuberculosis co-morbidity is rising, yet little work has been done to understand potential implications for health systems, healthcare providers and individuals. Kyrgyzstan is a priority country for tuberculosis control and has a 5% prevalence of diabetes in adults, with many health system challenges for both conditions.MethodsPatient exit interviews collected data on demographic and socio-economic characteristics, health spending and care seeking for people with diabetes, tuberculosis and both diabetes and tuberculosis. Qualitative data were collected through semi-structured interviews with healthcare workers involved in diabetes and tuberculosis care, to understand delivery of care and how providers view effectiveness of care.ResultsThe experience of co-affected individuals within the health system is different than those just with tuberculosis or diabetes. Co-affected patients do not receive more care and also have different care for their tuberculosis than people with only tuberculosis. Very high levels of catastrophic spending are found among all groups despite these two conditions being included in the Kyrgyz state benefit package especially for medicines.ConclusionsThis study highlights that different patterns of service provision by disease group are found. Although Kyrgyzstan has often been cited as an example in terms of health reforms and developing Primary Health Care, this study highlights the challenge of managing conditions that are viewed as “too complicated” for non-specialists and the impact this has on costs and management of individuals.

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Effect of diabetes on tuberculosis control in 13 countries with high tuberculosis: a modelling study

Cited by 75 publications

References 22 publications

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants

Diabetes and Tuberculosis

Addressing the double-burden of diabetes and tuberculosis: lessons from Kyrgyzstan

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