Abstract
Ageing population is attributable to the growing trend of diabetes mellitus. Diabetic patients are three times greater risk of developing tuberculosis. The review aims to describe the state of tuberculosis and diabetes mellitus comorbidity, risk factors for the comorbidity from the perspective of the ageing in Nepal. It is a systematic narrative review of literature in Google Scholar and Pubmed. At first, title and abstract of an article was reviewed for relevance, and then full article was reviewed for validity. The secondary data was retrieved from the Central Bureau of Statistics of Nepal and WHO, and analysed in the Ms-Excel. In Nepal, the population is ageing. The risk factors associated with diabetes are escalating. On the other hand, tuberculosis is endemic and about 45% of the Nepalese people are infected with tuberculosis bacteria. These circumstances have laid the foundation that fosters tuberculosis and diabetes co-epidemic in the future. The clinical management of patients with the comorbid condition is a difficult task because diabetes and tuberculosis interact with each other, one worsening the other.The upsurge of the co-morbidity needs the provision of more health services threatening the public health system of Nepal. It is fundamental to create a mechanism to integrate diabetes and tuberculosis program such as screening, diagnosis and management of the both diseases at the all levels of health service delivery. Furthermore, increase awareness of healthy lifestyle and the prevention of the risk factors for tuberculosis and diabetes could reduce the occurrence of the comorbidity in the future.
Highlights
METHODSThe ageing population is increasing in most countries and poses several public health challenges.[1]
Our study shows that the prevalence of TB and diabetes comorbidity is higher among the older ageing population
Relapse TB is highly associated with the development of MDR TB.51It is estimated that 13% growth in diabetes prevalence possibly will reduce the shrink in tuberculosis incidence by 8% or more.49,52People with diabetes who are diagnosed with TB have a higher risk of death during TB treatment
Summary
The ageing population is increasing in most countries and poses several public health challenges.[1]. TB diagnosis and treatment is problematic in elderly due to occurrence of acute or chronic diseases and weakened immune defense mechanism.[23] In addition, TB treatment among the elder population is challenging because of the amplified incidence of adverse drug reactions.[24] TB in elderly is regarded as public health challenge.[24] It was estimated, there were 526,000 cases of diabetes in 2015 with the prevalence of 9.1% in Nepal.[25,26] One third of diabetes patients remain undiagnosed.[27] The pooled prevalence of diabetes was 8.4%, ranging from a minimum of 1.4% to a maximum of 19.0%.28. The risk factors of comorbidity were older age, tobacco use, high income status and history of high blood pressure.[40] Nepal is facing the consequences of sedentary lifestyle leading obesity and metabolic syndrome.[41] Studies had shown the prevalence of overweight and obesity in certain sections of the population to be as high as 32.9% and 7.2% respectively. It means each year increase in TB patient with diabetes
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