Diabetes and tuberculosis co-epidemic: the Bali Declaration

Abstract

One-third of the world’s population is infected with Mycobacterium tuberculosis; in 2014 an estimated 9.6 million people developed active tuberculosis, with 1•5 million reported deaths from tuberculosis. An estimated 415 million people worldwide live with diabetes and another 318 million people have impaired glucose tolerance—a marker for future diabetes. By 2040 these numbers are likely to grow to 642 million and 481 million, respectively. 75% of all people with diabetes mellitus live in low-income and middle-income countries, with the disease escalating in the urban poor among whom tuberculosis also flourishes. These 2 diseases also interact. Diabetes is associated with a three-fold increased risk of tuberculosis. Diabetes complicates the diagnosis and management of tuberculosis and vice versa, and patients with both diseases can have more severe clinical manifestations, higher risks of treatment failure and death on treatment, and increased rates of recurrent tuberculosis after treatment has been completed. There are many uncertainties about optimum treatment strategies for patients with dual disease, including the length of tuberculosis treatment, appropriate dosages of the antibiotic rifampicin and oral sulphonylurea derivatives due to potential drug to drug interactions, and increased drug toxicity. This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)