Millions of people with high blood sugar across the globe are at greater risk of getting tuberculosis (TB); and when TB combines with diabetes, it can create a havoc of diseases.
A recent study -- conducted by the Diabetic Association of Bangladesh (BADAS) -- stated that TB prevalence is much higher among diabetic patients in Bangladesh.
TB is a communicable disease caused by Mycobacterium tuberculosis, which gets transmitted through air. It mainly affects the lungs and other organs of the body also. But it is curable and preventable.
The Financial Express (FE) recently interviewed Prof. Dr. M. Delwar Hossain, Director of Clinical Service, BIRDEM General Hospital and Head of Department of Respiratory Medicine. He is also Programme Director of International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b)-led USAID's Alliance for Combating TB in Bangladesh Activity, and BADAS TB Initiative.
Talking to the FE, he said diabetes slows down the body's natural defence system and allows it to develop TB. Diabetic patients are prone to develop different infections along with TB due to the immune defence deficit.
"Diabetes is a chronic, metabolic disease -- characterised by persistent elevation of blood glucose level in the body. This high blood glucose can weaken the immune system of the body (both cellular and humoral immunity)," he explained.
A large portion of the people with TB and TB-related deaths are reported from developing or poor countries, including Bangladesh.
According to the World Health Organisation's Global Tuberculosis Report 2022, a total of 307,561 people with TB were notified to the National Tuberculosis Control Programme (NTP) in 2021.
The incidence rate and mortality rate of TB in Bangladesh are 221 (per 100,000 population) and 25 (per 100,000 population) respectively.
From October 2020 to November 2022, BADAS, with the financial aid of USAID through icddr,b-led USAID's Alliance for Combating TB in Bangladesh Activity, identified and tested more than 70,000 presumptive persons, who had symptoms or signs suggestive of TB.
It also diagnosed TB in 6,702 persons nationwide, among whom 70 per cent were diabetic.
Under the leadership of NTP Bangladesh, the GO-NGO collaboration has proven to be the most effective model to eliminate TB. Though TB deaths declined significantly in Bangladesh over the last decade, Type-II diabetes is posing a threat.
"Rapid identification and early initiation of comprehensive treatment of people with TB can not only cure the disease, but also limit the chances of developing drug-resistance TB," Dr. Hossain suggested.
Treatment for those who have both TB and diabetes is more complex.
"Both the diseases (TB and diabetes) need to be treated simultaneously with equal importance. If we don't treat TB, it will be difficult to control the blood sugar level. On the other hand, if we don't control the blood sugar level, the anti-TB drugs will not work properly."
Diabetics also have some complications, such as kidney disease or chronic kidney failure, fatty liver, neuropathy, retinopathy, and also some co-morbid disease conditions such as heart disease, liver disease, etc.
"So, when treating TB-diabetics with such complications or co-morbid disease conditions, special attention from the respective specialist physician is needed," he noted.
"Diabetics are also more likely to fail in their TB treatment. If left untreated or inadequately treated, they may develop multidrug-resistance (MDR) or extensively drug-resistance (XDR) TB," he added.