Understanding the correlation between diabetes and tuberculosis

To answer the question of why diabetic patients are more susceptible to developing tuberculosis, the EU-funded TANDEM project linked leading European laboratories with field sites in TB-endemic countries such as Indonesia.

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Countries
Countries
  Algeria
  Argentina
  Australia
  Austria
  Bangladesh
  Belarus
  Belgium
  Benin
  Bolivia
  Brazil
  Bulgaria
  Burkina Faso
  Cambodia
  Cameroon
  Canada
  Cape Verde
  Chile
  China
  Colombia
  Costa Rica
  Croatia
  Cyprus
  Czechia
  Denmark
  Ecuador
  Egypt
  Estonia
  Ethiopia
  Faroe Islands
  Finland
  France
  French Polynesia
  Georgia


  Infocentre

Published: 13 November 2018  
Related theme(s) and subtheme(s)
Health & life sciencesMajor diseases  |  Medical research
International cooperation
Special CollectionsDiabetes  |  Tuberculosis
Countries involved in the project described in the article
Germany  |  Indonesia  |  Netherlands  |  New Zealand  |  Peru  |  Romania  |  South Africa  |  United Kingdom
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Understanding the correlation between diabetes and tuberculosis

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People with diabetes (DM) are three times more at risk of developing tuberculosis (TB). This is concerning because the number of type 2 DM cases continues to grow   among people originating from TB-endemic countries. Considering that pulmonary TB – a serious infection of the lungs – is spread from one person to another via coughing and sneezing, any increase in DM could easily translate into a worsened TB situation.

To better understand the relationship between the two diseases – and prevent their spread – the EU-funded TANDEM project linked leading laboratories in the Netherlands, Germany, and the United Kingdom with partners in Romania, Peru, South Africa and in Indonesia. “Our goal was to answer the question of why diabetic patients are susceptible to acquiring tuberculosis and how we can improve the clinical management of patients with concurrent TB and DM,” explains Bachti Alisjahbana, the senior researcher at Indonesia’s Padjadjaran University.

A number of important findings

A project partner, Padjadjaran University conducted several field studies, including a screening for TB and DM in diabetic and TB patients respectively. They also conducted a randomised trial of a structured clinical algorithm of TB-DM management, along with collecting data and samples that were then analysed by the project’s European partners.   

Based on this field research, the project partners made a number of important findings. Our research suggests that DM patients with latent TB infection are more likely to develop active TB, or TB infection with symptoms, compared to those without DM,” says Alisjahbana.

In latent tuberculosis infection (LTBI) a person is infected with TB but does not exhibit any symptoms.  “Because the identification and treatment of people with LTBI is an important part of controlling this disease, further studies should explore the possible benefits of LTBI screening and preventive therapy in DM patients living in a TB-endemic region,” adds Alisjahbana.

In terms of systematic screening, researchers found that computer-assisted chest radiography could be used for initial screening of diabetic patients for TB. This significantly reduces the number of DM patients who need to undergo microbiological examinations to confirm TB diagnosis, while also being useful in settings where radiologist expertise is lacking. Researchers also discovered that they could accurately diagnose diabetes in TB patients using simple point of care blood tests, which can be provided at the time and place of the patient care, thus reducing the need for more expensive and complex laboratory testing.   

In terms of treatment, one of the key breakthroughs stemming from the project’s field research is the recommendation that diabetic tuberculosis patients take metformin, a common drug for treating DM, and their TB drugs separately and always with food. “Doing so will greatly alleviate common gastrointestinal problems and other adverse side-effects,” explains Alisjahbana.

Continuing to benefit

Although the TANDEM project has officially closed, researchers at Padjadjaran University are continuing to benefit from their involvement. “Along with our partners, we are currently working with the Indonesian government to implement healthcare policies based on the findings from the TANDEM project,” says Alisjahbana. “These include proposals for conducting trials on implementing TB preventative measures, including systematic screening for TB among diabetic patients living in TB-endemic areas.”

Project details

  • Project acronym: TANDEM
  • Participants: UK (Coordinator), Germany, Netherlands, South Africa, New Zealand, Romania, Peru, Indonesia
  • Project N°: 305279
  • Total costs: € 7 988 142
  • EU contribution: € 5 998 496
  • Duration: February 2013 to July 2017

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