Integrated Management of Diabetes and Tuberculosis in Rural India – Results From a Pilot Study

Abstract

IntroductionThe World Health Organization and International Union against Tuberculosis (TB) recommends screening patients with TB for Diabetes Mellitus (DM) at the initiation of treatment. There are few pilot studies which screen TB patients for DM, but none of them have documented the feasibility of managing TB patients with DM in the Indian healthcare setting. Operational research is needed to determine the best way to manage individuals with both conditions. This pilot study aimed to develop, and field test an integrated, multidisciplinary program addressing the management of individuals with TB and DM and other associated chronic conditions in the Indian primary healthcare setting.MethodsThis pilot study used a randomized controlled trial design with mixed-methods evaluation and was conducted in Guntur district of Andhra Pradesh, a southern state of India. All the 120 patients newly diagnosed with TB from 10 participating villages were screened for DM and associated cardiovascular risk factors. Non-physician health workers were trained to follow-up patients for a period of 8 months to encourage treatment adherence, monitor treatment response including blood glucose levels and provide lifestyle advice.ResultsThe intervention was well-accepted by the providers and patients. However, there were no statistically significant variations observed for mean blood glucose levels (mean [SD]: 5.3 [−23.3 to 33.8]) of patients for both intervention and control group participants in this feasibility study. Awareness about diabetes and tuberculosis comorbidity and cardiovascular risk increased among the non-physician health workers in the intervention arm of the study.DiscussionThe co-management of TB-DM is acceptable to both the health providers and patients. With appropriate training, availability of infrastructure and planned intervention implementation, it is feasible to co-manage TB-DM within the existing primary health care system in India.

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

“…Nonphysician health workers were trained to encourage adherence to treatment and monitor treatment response including blood glucose levels and provide lifestyle advice and were considered as intervention arm. Although blood glucose levels in both arms of trial were similar, awareness about DM and TB comorbidity and cardiovascular risk increased in the intervention arm of the study 54 . Overall, this intevention strategy was well accepted by the patients and healthcare providers.…”

“…Overall, this intevention strategy was well accepted by the patients and healthcare providers. These authors concluded that with appropriate training, availability of infrastructure, and planned intervention implementation, it is feasible to co‐manage TB‐DM within the existing primary healthcare system in India 54 …”

“…These authors concluded that with appropriate training, availability of infrastructure, and planned intervention implementation, it is feasible to co-manage TB-DM within the existing primary healthcare system in India. 54 Overall, the findings show that although WHO first recommended collaborative activities to address TB and DM in 2011, implementation in India is variable and inadequate in many states and regions. It has been strengthened after a National Framework for Joint TB-Diabetes Collaborative Activities was laid down.…”

Tackling syndemics by integrating infectious and noncommunicable diseases in health systems of low- and middle-income countries: A narrative systematic review

“…The aim of most studies was to assess the feasibility of health service delivery adaptations in response to the COVID-19 pandemic ( Fig 4 ). As a result, 41 studies reported health service delivery outcomes, namely the healthcare process and models (n = 15) [ 40 , 80 , 83 , 87 , 88 , 91 , 93 , 95 , 98 , 101 , 102 , 105 , 108 , 111 , 118 ], adaptability (n = 15) [ 76 , 82 , 83 ], efficiency (n = 11), and cost (n = 1) [ 25 ]. The fifteen articles that reported on healthcare processes and models shared the design and feasibility of new models of care to sustain services during pandemic disruptions.…”

Prevalence of Pulmonary Tuberculosis in Diabetic Patients: Epidemiology, Immunological Basis, and Its Amalgamated Management

“…India is the highest-burden country with coexisting cases of diabetes and TB worldwide [ 32 ]. Hence, a patient diagnosed with TB should be screened for DM, as recommended by WHO [ 33 ]. But there are no international guidelines or national programs for the amalgamated management of diabetic patients affected by TB [ 34 ].…”