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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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 Indonesias 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 projects 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 projects 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.