Diabetes, TB often go hand in hand

TB patients much be screened for diabetes while diabetics should have at least a yearly check up for tuberculosis, say experts

A dual burden of diabetes and tuberculosis is looming large as these two diseases are found to affect a person at the same time and require active diagnosis and proper treatment.

The dual burden has been identified by the World Health Organisation and the organisation found that many diabetics who are suffering from tuberculosis are not diagnosed properly.

About 15 lakh cases of tuberculosis are found in India out of which over two lakh also have diabetes. India is one of the six countries in the world, which has a high number of cases related to tuberculosis.

There is a national policy that states people suffering from tuberculosis must be screened for diabetes but, unfortunately, it is not implemented properly due to which many cases go undetected. Diabetics are exposed to TB Diabetes affects the immune system adversely. The ability of the body to fight infections is altered and for that reason it is considered a secondary immune deficiency disorder.

Apart from the derangement in the immune system, diabetes causes changes in lung alveoli and bronchial reactivity, leading to decreased lung diffusion capacity and recoil. All these put a diabetic at two to five times higher risk of contracting TB. Recent studies show that approximately 18 per cent of people with lung TB have diabetes. Greater prevalence is seen in younger people, those with low body weight and type 1 diabetes.

Dr Sridevi Paladugu, consultant endocrinologist, Apollo Hospitals, said, “In majority of the cases (45 per cent), diabetes is detected first and is followed by TB. In about 25 per cent cases, TB is detected first followed by diabetes. In 20 per cent cases, both are detected simultaneously. For a diabetes patient it is important that the chest x-ray is taken every year as it helps diagnose TB. Also, the patient must reveal details if he or she comes in close contact to a TB infected person.”

TB must be managed properly

Risk of tuberculosis and its severity is more in patients with uncontrolled diabetes.

All diabetics need regular blood sugar monitoring and regular visits to the doctor. As per the national policy, all tuberculosis patients must be screened for diabetes but only those with high TB undergo the tests.

Dr S. Sunanda, senior consultant pulmonologist and sleep specialist at Care Hospitals, said, “The treatment for tuberculosis is aggressive. The drugs are given in multiple combinations, hence, adequate dosing according to body weight and also other ailments must be adhered to. For those who have diabetes and tuberculosis, there is a need for blood control. Also, it is important to counsel the patient to complete the full treatment as incomplete treatment leads to Multi-Drug Resistant Tuberculosis.” Stay away from those with active TB

There is no guideline to do testing for tuberculosis in all cases with diabetes. But it is important for medical practitioners to remember that as TB is very common in India, early diagnosis should be considered for patients with diabetes.

Dr S.V. Praveen, consultant internal medicine specialist at Citizen Hospital, said, “For diabetic patients it is important to avoid contact with positive TB patients. Their long-term exposure with these patients will make them susceptible to TB. There is a definite need for proper counseling of diabetes patients as lack of knowledge often leads to development of these diseases and then managing them poses a serious problem for the individual.”