Global Burden Of Diabetes Mellitus Research Articles

Impact of vitamin D on secretion and action on insulin: A glimmer of hope for the global burden of diabetes mellitus

Impact of vitamin D on secretion and action on insulin: A glimmer of hope for the global burden of diabetes mellitus

Exploration of macromolecular phenotype of human skeletal muscle in diabetes using infrared spectroscopy.

The global burden of diabetes mellitus is escalating, and more efficient investigative strategies are needed for a deeper understanding of underlying pathophysiological mechanisms. The crucial role of skeletal muscle in carbohydrate and lipid metabolism makes it one of the most susceptible tissues to diabetes-related metabolic disorders. In tissue studies, conventional histochemical methods have several technical limitations and have been shown to inadequately characterise the biomolecular phenotype of skeletal muscle to provide a holistic view of the pathologically altered proportions of macromolecular constituents. In this pilot study, we examined the composition of five different human skeletal muscles from male donors diagnosed with type 2 diabetes and non-diabetic controls. We analysed the lipid, glycogen, and collagen content in the muscles in a traditional manner with histochemical assays using different staining techniques. This served as a reference for comparison with the unconventional analysis of tissue composition using Fourier-transform infrared spectroscopy as an alternative methodological approach. A thorough chemometric post-processing of the infrared spectra using a multi-stage spectral decomposition allowed the simultaneous identification of various compositional details from a vibrational spectrum measured in a single experiment. We obtained multifaceted information about the proportions of the different macromolecular constituents of skeletal muscle, which even allowed us to distinguish protein constituents with different structural properties. The most important methodological steps for a comprehensive insight into muscle composition have thus been set and parameters identified that can be used for the comparison between healthy and diabetic muscles. We have established a methodological framework based on vibrational spectroscopy for the detailed macromolecular analysis of human skeletal muscle that can effectively complement or may even serve as an alternative to histochemical assays. As this is a pilot study with relatively small sample sets, we remain cautious at this stage in drawing definitive conclusions about diabetes-related changes in skeletal muscle composition. However, the main focus and contribution of our work has been to provide an alternative, simple and efficient approach for this purpose. We are confident that we have achieved this goal and have brought our methodology to a level from which it can be successfully transferred to a large-scale study that allows the effects of diabetes on skeletal muscle composition and the interrelationships between the macromolecular tissue alterations due to diabetes to be investigated.

Global burden of diabetes mellitus from 1990 to 2019 attributable to dietary factors: An analysis of the Global Burden of Disease Study 2019.

To analyse spatial and temporal changes in the global burden of diabetes mellitus (DM) attributable to dietary factors from 1990 to 2019. The burden of DM was analysed in terms of age-standardized disability-adjusted life-year (DALY) rates and age-standardized death rates (ASDRs), which were obtained from the Global Burden of Disease Study 2019, and their corresponding estimated annual percentage changes (EAPCs). The ASDR exhibited a decreasing trend (EAPC = -0.02), while the age-standardized DALY rate exhibited an increasing trend (EAPC = 0.65). Forty-four percent of the burden of DM was attributable to dietary factors, with the three largest contributors being high intake of red meat, high intake of processed meat, and low intake of fruit. Residence in a region with a high sociodemographic index (SDI) was associated with a diet low in whole grains and high in red meat and processed meat, while residence in a low-SDI region was associated with a diet low in whole grains and fruits, and high in red meat. The age-standardized DALYs of DM attributable to dietary factors increased between 1990 and 2019 but differed among areas. The three largest dietary contributors to the burden of DM were high intake of red meat, high intake of processed meat, and low intake of fruit.

Management of Type 2 Diabetes Mellitus and Kidney Failure in People with HIV-Infection in Africa: Current Status and a Call to Action.

There is an increasing global burden of diabetes mellitus (DM) and chronic kidney disease (CKD), coupled with a high burden of people with HIV (PWH). Due to an increased lifespan on ART, PWH are now at risk of developing non-communicable diseases, including DM. Africa has the greatest burden of HIV infection and will experience the greatest increase in prevalence of DM over the next two decades. In addition, there is a rising number of people with CKD and progression to kidney failure. Therefore, there is an urgent need for the early identification and management of all 3 diseases to prevent disease progression and complications. This is particularly important in Africa for people with CKD where there is restricted or no access to dialysis and/or transplantation. This review focuses on the epidemiology and pathophysiology of the interaction between HIV infection and DM and the impact that these diseases have on the development and progression of CKD. Finally, it also aims to review the data on the management, which stems from the growing burden of all three diseases.

DIABETES MELLITUS

Diabetes mellitus is a prevalent protracted metabolic disease marked by alarming blood glucose intensities and impaired insulin function. This research paper aims to investigate the prevalence, risk factors, complications, and management strategies of diabetes mellitus through a comprehensive literature review. The global burden of diabetes mellitus has reached epidemic proportions, imposing significant health and economic challenges. Risk factors contributing to the development of diabetes include obesity, sedentary lifestyle, genetic predisposition, and certain ethnic backgrounds. This paper explores the long-standing impediments associated with diabetes disorder, such as cardiovascular disease, retinopathy and nephropathy, underscoring importance of effective management. Various approaches to diabetes management have been studied, including lifestyle modifications, pharmacological interventions, and patient education. These interventions have shown promise in achieving glycemic control and preventing complications. However, treatment adherence, healthcare disparities, and limited access to quality care pose significant obstacles to successful management. By providing valuable insights into the multifaceted nature of diabetes mellitus, this research paper highlights the need for a comprehensive approach to its prevention, diagnosis, and management. Future research should focus on innovative strategies that improve patient outcomes, enhance healthcare delivery, and alleviate the global burden of diabetes mellitus. This research paper presents a thorough investigation into the prevalence, risk factors, complications, and management strategies of diabetes mellitus. By recognizing the impact of diabetes on individuals and society, it underscores the urgency of implementing effective preventive measures, early diagnosis, and comprehensive management strategies. Through ongoing research and collaborative efforts, it is possible to improve patient outcomes and reduce the global burden of diabetes mellitus.

Electrocardiogram abnormalities and renal impairment in patients with type 2 diabetes mellitus: A healthcare facilities-based cross-sectional study in Dang district of Nepal.

The global burden of diabetes mellitus is rising substantially, with a further increase in cardiovascular and kidney disease burden. These public health problems are highly prevalent in low- and middle-income countries, including Nepal. However, there is limited evidence on cardiac and renal conditions among patients with type 2 diabetes mellitus. We determined the status of electrocardiogram (ECG) abnormalities and renal impairment among patients with type 2 diabetes mellitus in Nepal. We carried out a cross-sectional study in Tulsipur Sub-Metropolitan City of Nepal using a multistage stratified sampling technique to recruit patients with type 2 diabetes mellitus. We used World Health Organization stepwise approach to surveillance (WHO STEPS) questionnaires and carried out resting ECG to collect data of 345 patients with type 2 diabetes mellitus. Logistic regression analysis assessed the factors associated with ECG abnormalities and renal impairment. The study showed that 6.1% of participants had major ECG abnormalities (95% confidence interval [CI] 3.8-8.6%), which were associated with hypertension (P=0.01%) and low socioeconomic status (P=0.01). The proportion of major and/or minor ECG abnormalities was 47.8% (95% CI 40.5-51%), and were significantly associated with age (odds ratio [OR] 1.04, 95% CI 1.01-1.07), higher education (OR 3.50, 95% CI 1.31-9.33), unemployment (OR 3.02, 95% CI 1.08-8.48), body mass index (OR 1.09, 95% CI 1.02-1.17) and duration of type 2 diabetes mellitus >5 years (OR 2.42, 95% CI 1.19-4.93). The proportion of renal impairment was 3.5% (95% CI 1.5-4.5%) which was associated with older age (OR 1.08, 95% CI 1.00-1.17) and hypertension (OR 12.12, 95% CI 1.07-138.22). A significant proportion of patients with type 2 diabetes mellitus had ECG abnormalities and renal impairment, which were significantly associated with hypertension. Therefore, hypertension management and early screening are essential to prevent future cardiorenal complications among patients with type 2 diabetes mellitus.

Diabetes in the Cook Islands: a clinical audit.

Introduction The global burden of diabetes mellitus (diabetes) is significant and of increasing concern with more pregnant women being diagnosed with gestational diabetes mellitus (GDM). The Cook Islands face mounting pressures to address diabetes alongside competing population health needs and priorities. Cook Islands residents frequently travel to New Zealand to access health services. Inadequate information systems also make it difficult for countries to prioritise preventative measures for investment. In the absence of good data to inform effective diabetes preventative and treatment measures, people with diabetes are likely to progress to complications which will burden society and health systems in the Cook Islands and New Zealand. Aim To determine the prevalence of diabetes and prediabetes, and incidence of GDM, in the Cook Islands. Methods We analysed two Te Marae Ora Cook Islands Ministry of Health datasets, the Non-Communicable Diseases (NCD) register examining demographic data for the period 1967 to December 2018 and same for the GDM register from January 2009 to December 2018. Results Of the 1270 diabetes cases, 53% were female and half were aged 45-64 years. There were 54 pre-diabetes cases and 146 GDM. Of the 20 GDM cases who developed type 2 diabetes, 80% were diagnosed before the age of 40 years. Data quality was poor. Discussion The Cook Islands diabetes registers provide important data to inform priorities for diabetes-related preventative and treatment measures. A data analyst has been employed to ensure quality, regularly audited data and information systems.

Clinical Characteristics and Factors Associated with In-Hospital Mortality in 66 755 Patients Hospitalized Due to Diabetes in Poland, January to December 2019.

BACKGROUND The global burden of diabetes mellitus is increasing, and diabetes poses a serious problem for the healthcare system. We aimed to characterize patients hospitalized due to diabetes in Poland in 2019 and identify factors associated with the risk of in-hospital death and prolonged hospitalization. MATERIAL AND METHODS Data on all patients hospitalized due to diabetes in Poland in 2019 were taken from hospital discharge records collected by the National Institute of Public Health, Warsaw, Poland. The presence of comorbidities, in-hospital mortality rate, and duration of hospitalization were analyzed separately for type 1 and type 2 diabetes. RESULTS In 2019, a total of 28 617 patients were admitted to the hospital due to type 1 diabetes and 38 138 patients due to type 2 diabetes. The prevalence of comorbidities was 55.2% among patients with type 1 diabetes and 78.9% among those with type 2 diabetes. The in-hospital mortality rates were 2.1% and 3.3%, respectively. For emergency admissions, the in-hospital mortality rate was 4.0% and 4.5%, respectively. Over 30% of patients were hospitalized for more than 7 days. Older age and respiratory diseases were the most critical factors associated with higher risk of in-hospital death in patients with type 1 or type 2 diabetes (P<0.001). Male sex, age, and presence of at least 1 comorbidity were associated (P<0.001) with a higher risk of prolonged hospitalization. CONCLUSIONS Effective management of respiratory diseases in patients hospitalized due to diabetes, especially those admitted in an emergency, seems crucial to reduce the risk of in-hospital death.

Reducing blood glucose levels in the elderly with diabetes mellitus using ergonomic exercise based on spiritual care

The increasing number of people with diabetes has an impact on the global burden of diabetes mellitus (DM) becoming a major public health priority, placing unsustainable demands on individuals, their guardians, economies, health systems and society. The increase in the number of DM is influenced by the increase in the prevalence of obesity and unhealthy behaviors including poor diet and physical activity. In reducing the morbidity rate, there needs to be an effort to control blood glucose levels, one of which is ergonomic exercise based on spiritual care. The purpose of this study was to determine the effect of ergonomic exercise based on spiritual care on blood glucose in the elderly with diabetes mellitus. The design of this study used a quasi-experimental with a control group. The population of this study were all elderly people with diabetes mellitus. The sample of this study was 104 respondents, divided into 52 intervention groups and 52 control groups. This research instrument uses an observation sheet. This research was conducted in April - June 2022. The results of this study obtained an average blood glucose level in the intervention group 2.69 and in the control group 2.70 with p value = 0.957.

Interleaved Optical Coherence Tomography: Clinical and Laboratory Biomarkers in Patients with Diabetic Macular Edema.

(1) Background: The global burden of diabetes mellitus (DM) has been estimated to reach 600 million patients worldwide by 2040. Approximately 200 million people will develop diabetic retinopathy within this time frame. Diabetic macular edema (DME) is a severe, vision-threatening complication that can develop at any stage of diabetic retinopathy, and it represents the main cause of vision loss in patients with DM. Its harmful consequences on visual function could be prevented with timely recognition and treatment. (2) Methods: This study assessed the clinical (demographic characteristics, diabetic evolution, and systemic vascular complications); laboratory (glycated hemoglobin, metabolic parameters, capillary oxygen saturation, and renal function); ophthalmologic exam; and spectral-domain optical coherence tomography (SD–OCT) (macular volume, central macular thickness, maximal central thickness, minimal central thickness, foveal thickness, superior inner, inferior inner, nasal inner, temporal inner, inferior outer, superior outer, nasal outer, and temporal outer thicknesses, disruption of the ellipsoid zone, and disruption of the inner retinal layers (DRIL) parameters in three groups of individuals: healthy controls (HC), patients with DME and type 1 DM (T1DM—group A), and patients with DME and type 2 DM (T2DM—group B) to identify novel correlations between them that would open a path to new pathogenetic hypotheses and, implicitly, to the identification of new therapeutic methods, as part of a tailored treatment within the concept of precision medicine. (3) Results: The duration of DM was significantly longer in group A as compared with group B, as were the prevalence of smoking and systemic vascular complications. Capillary oxygen saturation and estimated glomerular filtration rates were significantly lower, and serum creatinine levels were significantly higher in group A as compared to group B. Regarding the OCT findings, DME had a predominantly eccentric pattern, and the right eye was more severely affected in both groups of patients. Significantly higher values were obtained in group B as compared to group A for the following OCT biomarkers: macular volume, central macular thickness, maximal central thickness, minimal central thickness, foveal thickness, superior inner, inferior inner, nasal inner, inferior outer and nasal outer thickness. The disruption of the ellipsoid zone was significantly more prevalent within group A, whereas the overall disruption of the retinal inner layers (DRIL) was identified significantly more frequently in group B. (4) Conclusions: Whereas systemic and laboratory biomarkers were more severely affected in patients with DME and T1DM, the OCT quantitative biomarkers revealed significantly higher values in patients with DME and T2DM.

Therapeutic efficacy of Clompanus pubescens leaves fractions via downregulation of neuronal cholinesterases/Na+-K+ATPase/IL-1 β, and improving the neurocognitive and antioxidants status of streptozotocin-induced diabetic rats

The increasing global burden of diabetes mellitus has called for the search for a therapeutic alternative that offers better activities and safety than conventional chemotherapy. Herein, we evaluated the neuroprotective and antioxidant properties of different fractions (ethyl acetate, N-butanol and residual aqueous) of Clompanus pubescens leaves in streptozotocin (STZ)-induced diabetic rats. Our results revealed a significant elevation in the levels of blood glucose, pro-inflammatory cytokines, lipid peroxidation, neuronal activities of acetylcholinesterase, butyrylcholinesterase, nitric oxide, epinephrine, norepinephrine, and Na+/K+-ATPase in diabetic non treated rats. In addition, decreased levels of enzymatic and non-enzymatic antioxidants were observed. Treatment with different fractions of C. pubescens leaves resulted in significant reversal of the biochemical alteration and improved the neurocognitive deficit in STZ induced diabetic rats. However, the ethyl-acetate fraction demonstrated higher activities than the other fractions and was characterized for its phytoconstituents, revealing the presence of Gallic acid (713.00 ppm), catechin (0.91 ppm), ferulic acid (0.98 ppm), rutin (59.82 ppm), quercetin (3.22 ppm) and kaempferol (4.07 ppm). Our molecular docking analysis revealed that these compounds exhibited different binding affinities and potentials for targeting BChE/AChE/ IL-1 β/Na+ -K+ -ATPase. However, only Kampferol and ferulic exhibited good drug-like, ADMET, and permeability properties suitable for use as a neuronal drug target agent. Hence, the ethyl-acetate fraction of C. pubescens leaves could be considered as a source of promising bioactive metabolite for the treatment and management of cognitive impairments related to type II diabetes mellitus.

Biomarkers for early diagnosis of diabetic kidney disease: still a long way to go.

Biomarkers for early diagnosis of diabetic kidney disease: still a long way to go.

Histone Deacetylases in the Pathogenesis of Diabetic Cardiomyopathy.

The global burden of diabetes mellitus and its complications are currently increasing. Diabetic cardiomyopathy (DCM) is the main cause of diabetes mellitus associated morbidity and mortality; therefore, a comprehensive understanding of DCM development is required for more effective treatment. A disorder of epigenetic posttranscriptional modification of histones in chromatin has been reported to be associated with the pathology of DCM. Recent studies have implicated that histone deacetylases could regulate cardiovascular and metabolic diseases in cellular processes including cardiac fibrosis, hypertrophy, oxidative stress and inflammation. Therefore in this review, we summarized the roles of histone deacetylases in the pathogenesis of DCM, aiming to provide insights into exploring potential preventative and therapeutic strategies of DCM.

Spectrum of Diabetic Lesions

Background: The aim of our study was to study the gross morphological changes, histopathology, prevalence, and characteristics of pathological lesions in various organs in patients of diabetes mellitus; to determine the contribution of diabetes to mortality; and to study complications of diabetes mellitus in the cases studied. Materials and Methods: Ours was a descriptive cross-sectional study of a five-year duration carried out at a tertiary care hospital. A complete medical autopsy was done of all the cases; all organs were examined grossly and microscopically, and their details were recorded. Results: A total of 137 patients with diabetes were studied at autopsy. Overall, 32.8% of the patients with diabetes were in the age group of 61–70 years, with a female:male ratio of 1.2:1. The highest frequency of deaths was due to diseases of the cardiovascular system (39%), whereas both septicemia and diseases of the respiratory system followed as a close second (37%). Overall, 10.94% patients died due to diseases of the central nervous system. Conclusion: The global burden of diabetes mellitus is increasing worldwide, and it is necessary to have an improved understanding of its etiology, pathogenesis, and pathophysiology to focus therapeutic and research efforts appropriately to reduce its effects on lives and economies.

PHOENIX DACTYLIFERA FRUIT EXTRACT AMELIORATES ALTERED BIOCHEMICAL PARAMETERS IN STREPTOZOTOCIN-INDUCED DIABETES MELLITUS ALBINO RATS

Objective: Consistent projections have indicated a steady increase in the global burden of diabetes mellitus. Given the increased cost in conventional management of the condition in addition to reported side effects and cost of orthodox management, attention is shifting to the use of alternative methods such as plants materials with dual benefits as food and medicine. Thus, this study was designed to investigate the effect of date palm fruit on some biochemical parameters in streptozotocin-induced wistar rats.&#x0D; Methods: Animals were divided into 5 groups of 6 rats each (I as normal control, II as diabetic control and 3-5 as extract-treated groups) maintained for 14 d. At the end of the treatment, the animals were fasted overnight, then sacrificed and blood samples collected for analysis of biochemical parameters (including blood glucose, blood lipids and enzymes).&#x0D; Results: The results show that treatment of diabetic animals with extract of date palm fruit show a significant (P&lt;0.05) reduction in glucose levels in groups II–V compared to group I. Similar positive effects were observed in the levels of lipids and enzymes in treated groups compared to diabetic control group II. A GC-MS analysis of the fraction of the fruit extract revealed some bioactive compounds that may be responsible for the effects exhibited in the study.&#x0D; Conclusion: These findings which demonstrate the ameliorative effect on hyperglycemia and hyperlipidemia, further support the use of date palm fruit as a nutraceutical agent.

Peripheral neuropathy in a diabetic child treated with linezolid for multidrug-resistant tuberculosis: a case report and review of the literature

BackgroundExtensively drug-resistant (XDR) tuberculosis (TB) and multidrug resistant (MDR)-TB with additional resistance to injectable agents or fluoroquinolones are challenging to treat due to lack of available, effective drugs. Linezolid is one of the few drugs that has shown promise in treating these conditions. Long-term linezolid use is associated with toxicities such as peripheral and optic neuropathies. Diabetes mellitus (DM), especially when uncontrolled, can also result in peripheral neuropathy. The global burden of DM is increasing, and DM has been associated with a three-fold increased risk of developing TB disease. TB and DM can be a challenging combination to treat. DM can inhibit the host immune response to tuberculosis infection; and TB and some anti-TB drugs can worsen glycaemic control. A child experiencing neuropathy that is a possible complication of both DM and linezolid used to treat TB has not been reported previously. We report peripheral neuropathy in a 15-year-old boy with type 1 DM, diagnosed with MDR-TB and additional resistance to injectable TB medications.Case presentationThe boy was treated with a linezolid-based regimen, but after 8 months developed peripheral neuropathy. It was unclear whether the neuropathy was caused by the DM or the linezolid therapy. He had clinical improvement following cessation of linezolid and was declared cured following 21 months of treatment. Following completion of treatment, nerve conduction studies demonstrated significant improvement in neuropathy.ConclusionsTo the best of our knowledge, this is the first case of peripheral neuropathy reported in a diabetic child on long-term linezolid therapy for tuberculosis. This case study underlines the importance of stringent follow-up for side effects of linezolid, especially when associated with co-morbidity such as DM that increases the chances of adverse effects. The presence of both DM and TB should alert a physician to strive for optimal glycaemic control to minimize the risk of complications as well as optimizing the chances of recovery from TB. Our case report shows the need for close and frequent monitoring for neuropathy to enable early intervention and thereby a favourable outcome in children who may otherwise suffer a long-lasting, debilitating, and painful neuropathy.

Diabetic cardiomyopathy: where we are and where we are going.

The global burden of diabetes mellitus and its related complications are currently increasing. Diabetes mellitus affects the heart through various mechanisms including microvascular impairment, metabolic disturbance, subcellular component abnormalities, cardiac autonomic dysfunction, and a maladaptive immune response. Eventually, diabetes mellitus can cause functional and structural changes in the myocardium without coronary artery disease, a disorder known as diabetic cardiomyopathy (DCM). There are many diagnostic tools and management options for DCM, although it is difficult to detect its development and effectively prevent its progression. In this review, we summarize the current research regarding the pathophysiology and pathogenesis of DCM. Moreover, we discuss emerging diagnostic evaluation methods and treatment strategies for DCM, which may help our understanding of its underlying mechanisms and facilitate the identification of possible new therapeutic targets.

Diabetes mellitus and obstructive sleep apnoea: implications for clinicians

Diabetes mellitus (DM) is a major public health problem globally. Current estimates suggest a significant increase in the global burden of DM in the years to come. Sleep disordered breathing (SDB) is an emerging health concern world over. Evidence is available suggesting that obstructive sleep apnoea (OSA) is considered to be both the cause and consequence of DM. Due to lack of awareness regarding the condition and non-availability of diagnostic facilities, OSA remains an underdiagnosed problem in patients with DM, in developing countries like India. Early detection of OSA in patients with DM and assessment for DM in those with OSA can potentially reduce cardiovascular disease risk and improve the quality of life in these patients.

Design of an allele-specific PCR assay to genotype the rs12255372 SNP in a pilot study of association between common TCF7L2 polymorphisms and type 2 diabetes in Venezuelans.

The global burden of diabetes mellitus will impact strongly American countries in the coming decades. Type 2 diabetes mellitus (T2DM) is a multifactorial disease and the basis for its genetic susceptibility remains not fully understood. Different population studies have demonstrated that variants of the TCF7L2 gene are strongly associated with an increased risk of T2DM. Moreover, institutions or countries with limited budget to conduct genetic research need cost effective methods for detecting DNA variants. We standardized a rapid and simple allele-specific PCR method for genotyping the rs12255372 single nucleotide polymorphism (SNP) in a pilot study exploring the association of three TCF7L2 polymorphisms (rs7903146, rs12255372 and DG10S478) with T2DM in 70 patients and 73 controls from Venezuela. The performance of the designed allele-specific PCR reaction for rs12255372 genotyping was reliable and accurate. Patients carrying the TCF7L2 rs7903146 T allele (CT + TT genotypes) and heterozygous CT genotype had a significantly higher risk for T2DM (OR = 2.9 and 2.3, respectively). Although rs12255372 and DG10S478 risk alleles predominated in T2DM group no statistical significance was found. We developed a novel allele-specific PCR method for easier and rapid detection of rs12255372 polymorphism without the use of expensive instrumentation and reagents. Our study in a relatively small sample of the Venezuelan population replicated the association of the rs7903146 SNP with T2DM. Further studies with larger sample size and more biochemical data should be conducted to explore the genetic basis of T2DM susceptibility in Venezuela.

Diabetes mellitus and tuberculosis: programmatic management issues.

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.