What is the extent of diabetes in India?
India ranks second, next to China, for the highest number of people living with diabetes. Apart from certain genetic predispositions, other factors such as unhealthy eating habits, physical inactivity, sedentary lifestyle and stress are added reasons for an expanding diabetic population.
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People with diabetes are prone to develop complications of the heart, eyes, kidney and foot. In addition, they are more likely to acquire infections as their immune system is compromised due to fluctuations in blood glucose levels. The ability to fight against infections is comparatively lower in diabetics. India has a huge burden of tuberculosis. Moreover, the number of people with latent TB infection is also high. Ten out of 100 people with latent TB infection develop the active form of TB during their lifetime; whereas diabetic patients with latent TB infection are three times more likely to develop active TB. The increasing number of diabetics in India indirectly increases the number of people with active TB, facilitating the persistence of TB in the community.
Does TB relapse in diabetics?
Recent studies on patients with TB and Diabetes Mellitus (DM) also showed that diabetes facilitates the reactivation of TB in people who have already completed the treatment. The increased blood glucose levels over a period impair the defensive mechanism essential to fight against the invading bacteria/viruses.
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How many TB patients have diabetes and pre-diabetes?
A recent study among TB patients showed that people with diabetes and pulmonary TB are more likely to have sputum positive or the infectious form. About one fourth of TB patients had diabetes and another one fourth were in the pre-diabetes stage; half had abnormal blood sugar levels. Hence the dual burden of TB and diabetes poses a great challenge to control both communicable and non communicable diseases.
What is the most important step to address this double burden?
It is necessary to unmask undiagnosed diabetes among TB patients; so it is important to screen all TB patients for diabetes. TB patients diagnosed with diabetes and already under treatment for that have to be monitored carefully for blood glucose control. It helps to control both diseases effectively.
How does a DM patient exhibit TB symptoms?
Diabetes may also influence the way that TB can present. Diabetic patients may or may not have the common symptoms of TB such as cough, evening rise of temperature, loss of weight, loss of appetite and night sweating. The radiological picture in chest x-rays may also not be the same as that of patients with only TB. A routine screening for TB symptoms in people treated in diabetes clinics along with the screening for other complications is also important. Those who present with TB symptoms such as persistent cough for more than 10 days and not responding to antibiotics must undergo sputum tests or chest x-rays to rule out TB.
Are there any special steps to control both diseases?
TB patients are more likely to develop uncontrolled blood sugar due to the chronic infectious stage. Monitoring blood sugar values and adjusting the diabetic drug/dose with an expert’s advice is very important. If diabetic patients without complications are diagnosed with TB and start treatment, a screening for complications of diabetes should be done at the end of TB treatment. When diabetic patients with complications are put on TB treatment, a close monitoring is needed to prevent any untoward events. It is necessary to get dietary advice to improve protein content of the total daily intake if the calorie consumption is adequate. A well balanced diet with essential vitamins and minerals is generally recommended. Once TB treatment is started and patient gets some relief, a moderate level of physical activity can be maintained.
What is expected from a patient with both TB and DM?
It is a great challenge to manage both the diseases, as it needs the full cooperation of the patients, both in terms of taking prescribed medicines for both diseases and monitoring. The general public should be aware of the possibility of coexistence of the two diseases, particularly the high risk group i.e. those who are being treated for either one.