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Abstract
SUMMARYIn August 2011, the World Health Organization and the International Union Against Tuberculosis and Lung Disease launched the Collaborative Framework for Care and Control of Tuberculosis (TB) and diabetes mellitus (DM) to guide policy makers and implementers in combatting the epidemics of both diseases. Progress has been made, and includes identifying how best to undertake bidirectional screening for both diseases, how to provide optimal treatment and care for patients with dual disease and the most suitable framework for monitoring and evaluation. Key programmatic challenges include the following: whether screening should be directed at all patients or targeted at those with high-risk characteristics; the most suitable technologies for diagnosing TB and diabetes in routine settings; the best time to screen TB patients for DM; how to provide an integrated, coordinated approach to case management; and finally, how to persuade non-communicable disease programmes to adopt a cohort analysis approach, preferably using electronic medical records, for monitoring and evaluation. The link between DM and TB and the implementation of the collaborative framework for care and control have the potential to stimulate and strengthen the scale-up of non-communicable disease care and prevention programmes, which may help in reducing not only the global burden of DM but also the global burden of TB.
Highlights
IN 2007 AND 2008, two systematic reviews of the medical literature alerted the scientific community to the important association between diabetes mellitus (DM) and tuberculosis (TB).[1,2] The studies demonstrated that the relative risk of TB in cohorts of DM patients compared with normal subjects was 3.1 (95% confidence interval 2.3–4.3), and that the odds ratios of TB occurring in persons with DM in casecontrol studies varied from 1.2 to 7.8
The link between the two diseases has been known for years from anecdotal reports, case studies and clinical experience, the implications of this interaction for public health were thought until recently to be insignificant, as TB is relatively rare in high-income countries where DM is prevalent, and DM is perceived as being a minor problem in lowand middle-income countries (LMICs) where TB is epidemic
No evidence to support screening for latent tuberculous infection (LTBI) in DM clinics, and this approach is not recommended in the World Health Organization (WHO)-Union Framework nor in the recent WHO guidelines on the management of LTBI.[10,36]
Summary
In August 2011, the World Health Organization and the International Union Against Tuberculosis and Lung Disease launched the Collaborative Framework for Care and Control of Tuberculosis (TB) and diabetes mellitus (DM) to guide policy makers and implementers in combatting the epidemics of both diseases. The link between the two diseases has been known for years from anecdotal reports, case studies and clinical experience, the implications of this interaction for public health were thought until recently to be insignificant, as TB is relatively rare in high-income countries where DM is prevalent, and DM is perceived as being a minor problem in lowand middle-income countries (LMICs) where TB is epidemic This perception has changed radically in the last decade with the recognition of the huge, unfolding epidemic of DM in LMICs, the slower decline in global TB incidence than would be expected from epidemiological modelling and a better understanding of how DM and TB interact. [A version in French of this article is available from the Editorial Office in Paris and from the Union website www.theunion.org]
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