#1 Where does the double burden between diabetes mellitus type 2 and tuberculosis come from?
Diabetes and Tuberculosis (TB), are both well known diseases, but together many people don’t know why they can be so problematic. So, exactly what is the double burden of Diabetes and Tuberculosis? To answer that question, we briefly have to understand what both diseases are.
Diabetes
Diabetes is a disease where the pancreas produces no insuline (Diabetes type 1) or ineffective (Diabetes type 2) amount or of insulin. This leads to poor glucose regulation in the body. For this blog we focus on type 2 Diabetes (T2DM). Ways to prevent or delay T2DM consist of physical activity, healthy body weight, healthy diet and avoiding tobacco use. The treatment with insulin, other medication, healthy diet, physical activity and regular screening is necessary for patients with T2DM to delay the health consequences. When T2DM is not treated on time or incorrectly, patients have an increased risk for heart failure, strokes, reduced blood flow, nerve-, blood vessel damage, kidney failure or even blindness.
In 2019, the worldwide prevalence of diabetes is estimated to be 463 million people (9,3% from the whole world population), from which approximately 90% is T2DM. This number will grow to an estimated 578 million people in 2030 and 700 million within 2045. The prevalence of T2DM is increasing most rapidly in low- and middle income countries, such as countries in the Southern region of Africa. Moreover, 80% of the T2DM related deaths occur in low- and middle income countries as well. Meaning that these countries now carry most of the burden of T2DM.
Tuberculosis
Furthermore, TB is an infectious disease, caused by mycobacterium tuberculosis. Risk groups for TB include people who suffer from diabetes, HIV, malnutrition or people who use tobacco. From TB there is an active and a latent form. The active form mostly results in the lungs with symptoms like coughing, weight loss, fever or in the most severe form death. When the infection is active, a patient can spread the disease by sneezing, coughing or spitting. The bacteria spreads through airborne droplets in the air. The infection is curable with the use of different antibiotics.
In 2018, the WHO estimated that 2.5 million people got contaminated with TB in the African region, and 417.000 people died as a consequence. Both numbers account for approximately 25% of the global rates, which shows the relevance of the TB problem in Africa. As shown in the figure below, most TB cases in Africa are located in the Southern part of Africa. However, the rates differ greatly per country in Southern Africa. The countries in Africa in which the most cases of TB are estimated are South Africa, with a rate of 360.000 cases, Angola, with a rate of 112.000 cases, and Mozambique, with a rate of 110.000 cases. And it remains the leading mortality cause in South Africa.
Figure 1: Countries that has at least 100,000 incidents cases of TB in 2019 from WHO (2019)
T2DM & TB
So, both the diseases are treatable, but what is the case if somebody suffers from both diseases? People with diabetes are three times more likely to develop TB. When a diabetes patient gets infected with TB, the comorbidity can cause serious effects. T2DM influences the clinical course of TB and increases the risk of death. In addition, TB can influence the control over the blood sugar levels. Controlling blood sugar levels are very important for maintaining a good health state. When a patient happens to be diagnosed with TB and T2DM, they need specifiek clinical management to address both diseases.
Southern Africa
In our region, Southern Africa, this can result in a public health problem, due to a lack of several resources to address both diseases. The health system within Southern Africa faces problems with screening, early diagnosis, sufficient treatment and the quality of care to address both diseases. Individuals face problems with addressing the diseases due to unawareness of the diseases or not enough money to afford for treatments. In the case of TB people suffer from a lack of preventable resources, like hygiene precautions or knowledge about the transmission. Furthermore, in the case of T2DM, people lack knowledge or ways to treat or delay the disease. For example, money to pay for a healthy diet, or knowledge about what a healthy lifestyle is.
So, all of this results in a double burden of disease between T2DM and TB, but what can we do about this? Next week we will look further into lifestyle choices beneficial to prevent and manage T2DM and TB disease on an individual level! Because the highest prevalence is South Africa we wil further zoom in on the cases and health system there.
Written by Marlou Mizee
