14 November 2020, Geneva | Tuberculosis (TB) remains the world’s top infectious killer claiming 1.4 million lives in 2019. As we mark World Diabetes Day on 14th November, we need to underscore the role of diabetes as a key driver for TB and a risk factor for poor tuberculosis treatment outcomes in people with diabetes. Diabetes is also associated with a two-fold risk of death during TB treatment and a four-fold risk of TB relapse after treatment completion. Diabetes is associated with a 2-3 times increased risk of TB, including drug resistant TB. Evidence suggests that the risk of TB increases with poorly managed diabetes. Diabetes was the cause of TB in an estimated 350,000 people in 2019 – many of which could have been prevented had diabetes been prevented or well managed. Diabetes and TB place a heavy dual burden on those ill with both diseases.
More than 420 million people are living with diabetes, and it is unfortunately on the rise in countries with a high burden of TB and where the basic technology for diagnosing and treating diabetes is often lacking in primary care and the public sector. The negative impact of COVID-19 on access to early diagnosis and management of diabetes is likely to further fuel the tuberculosis and diabetes epidemics.
“Disruption of treatment and delays in follow-up experienced during the COVID-19 pandemic will likely increase the number of people who are susceptible to a recurring or new episode of TB. This is one of the reasons why WHO is announcing the WHO Global Diabetes Compact, a comprehensive and inclusive approach to support countries in implementing effective programmes for the prevention and management of diabetes” said Dr Bente Mikkelsen, Director NCDs at WHO.
This all strengthens the case for expanding access to integrated, bidirectional screening and co-management of TB and diabetes. It also calls for increased investment in the prevention, diagnosis and treatment of diabetes as critical interventions for ending TB. In 2018, at the respective UN High-Level Meetings on TB and non-communicable diseases (NCDs), Member States committed to strengthening integrated care for TB and NCDs such as diabetes. However, implementation in high TB burden countries is still limited.
“Diabetes is an increasingly important determinant of TB, and the main driver of TB epidemics in several countries in Latin America. Prevention and effective management of diabetes are essential to reducing the risk of TB. As we work to assure Universal Health Coverage in the context of the COVID-19 pandemic, now is the time to work together to build synergies and strengthen the primary health care platform for the future. Now is the time to consider common strategies to address COVID-19, diabetes and TB, and expand access to prevention, diagnosis and comanagement, as well as strengthen infection control measures,” said Dr Tereza Kasaeva, Director of WHO’s Global TB Programme. “And now is the time to work with stakeholders across sectors and funding agencies to push forward the common agenda and to ensure accountability”.