This blog post focuses on the rise of Diabetes Mellitus (DM) and how this influences the fight against tuberculosis. First it is important to explain more about DM. DM is a group of metabolic diseases that are al characterized by high blood sugar levels.
- In type I DM these high blood sugar levels occur because the body can’t make insulin, that normally lowers the blood sugar levels.
- In type II DM the body has resistance to insulin action and the body can’t make enough insulin.
There is no cure for diabetes, but with the right medicines and lifestyle changes people with diabetes live a happy life. However, if DM is not recognized and treated well, it can be very dangerous and long term complications can occur. Long term complications of DM are among others loss of vision, kidney failure, food ulcers or amputation and sexual dysfunction. In the video below the life of a young boy diagnosed with DM type I in Tanzania is shown. It provides some examples of the challenges people with DM face in Eastern Africa.
There are several risk factors for developing diabetes. These are overweight – in particular belly fat -, high cholesterol levels, a family history with diabetes, high blood pressure, smoking and ageing. Because changes in lifestyle causing an increase in overweight, high blood pressure and high cholesterol levels, the burden of DM increases. The table below shows this increase in several countries in Eastern Africa.
People with DM are more susceptible for developing Tuberculosis (TB), it increases the risk three times. Also patients with TB are four times more likely to relapse on TB and twice likely to die from TB. The video below provides a quick explanation about TB.
The increase in the prevalence of DM causes an increase in the relative contribution of DM to the TB-endemic. Thus in preventing DM there is a potential to improve the tuberculosis control. The WHO developed a Collaborative Framework for Care and Control of Tuberculosis and Diabetes. This framework provides twelve recommendations to tackle TB and DM together. Two recommendations are for instance to screen TB in people diagnosed with DM and vice versa. There are several projects going on to tackle DM and TB together in Eastern Africa. For example a project in
Burundi funded by the World Diabetes Foundation. This project raises awareness of DM in people diagnosed with TB and improves prevention, early detection and quality of care for people with both DM and TB. In six hospitals there will be staff trained in TB and DM screening and management. Also the expectation is that during the project runs 2.500 people with TB will be screened for DM, awareness will raise in 1500 people at risk, 6.500 people with diabetes will be screened for TB and 312 people with diabetes will be diagnosed with TB. At last there will be mechanisms established to monitor both DM and TB. By projects such as this project one day the fight against DM and TB will be successful!
Sources used:
– https://onlinelibrary-wiley-com.vu-nl.idm.oclc.org/doi/full/10.1111/j.1365-3156.2010.02625.x
– https://www.rivm.nl/tuberculose
– https://care-diabetesjournals-org.vu-nl.idm.oclc.org/content/36/Supplement_1/S67
– https://www.diabetesfonds.nl/over-diabetes/heb-ik-diabetes/wie-loopt-meer-risico-op-diabetes
– https://apps.who.int/iris/bitstream/handle/10665/44698/9789241502252_eng.pdf;jsessionid=251304848460B7C812F268269E33096D?sequence=1
– https://www.worlddiabetesfoundation.org/projects/burundi-wdf15-953
– https://www.diabetesatlas.org/en/
– https://www.youtube.com/watch?v=nyIkMWN7Dm0
– https://www.youtube.com/watch?v=N0Gv96uDctM
East Africa 
Hi all,
First of all, I really enjoyed reading your post about the Double Burden of Tuberculosis and Diabetes. As I’m writing my essay on this topic as well, I found it interesting to read that the WHO has already came up with a framework that addresses both diseases at the same time. I think, especially because these diseases are highly linked to each other, it is important and effective to develop combined interventions. With regard to the connection of the two diseases, I might have a tip for you guys. In the post you mention the biological connection between both diseases, but maybe you can also mention an economic connection. For example, that both diseases put a high burden on individual and institutional level when it comes to the health care costs that are accompanied with both diseases. In this way, the problem of the double burden is emphasized even more. I would say keep up the good work and I’m looking forward to reading your next work!
Kind regards,
Anouk Haremaker
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Dear Anouk,
Thanks for your comment! We hope this blog post provide you with some information that you can use for your essay. You are very right that the double burden of disease can be viewed in different ways. Of course there is the biological perspective that we mention in the blog post, the burden on health care that you mention in your comment and besides that there is even another perspective. Both diseases share a same underlying cause: namely poverty. For example poverty leads to overcrowding and poor ventilation and these are causes that increase the risk in exposure to TB. Also poverty influences diabetes, for instance by poorer people eating in general unhealthier food. All in all there are several ways to look at the burden of disease. We chose to focus on the biological way, instead on all several ways to keep the blog post short. We appreciate that you shared your knowledge in the comments so other people visiting our blog post will learn from this.
Kind regards,
Imke, Jinke, Joanne, Marieke and Thom
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Hello everyone,
I’ve really enjoyed following along with your blog. It’s very clean, organized, and professional looking. I especially love your guys’ use of videos and charts to explain the data and seriousness of your issue. This is a good technique to have for those that are visual learners. It was also interesting to look further into the sites that you all provided at the bottom of the post. I think your blog has made amazing progress and I look forward to seeing the final piece!
Hope you all ever a good weekend!
Emily McDowell
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Dear Emily
Thanks for your comment. We like to hear that you enjoy visiting our blog and that you make use of the different resources we provide.
Kind regards,
Imke, Jinke, Joanne, Marieke and Thom
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Dear group,
I would like to compliment you on your blog, it is very clear, has a nice layout and interesting blog posts. I have enjoyed reading it! Also, this blog post was very interesting. I liked the fact that you have used movies to further explain/clarify the subject, this gives your blog a new creative aspect.
I was surprised to read that there are already some interventions for this double burden. So firstly, I was curious whether the effectiveness of these interventions is already known and if similar programmes are also being set up in other East Asian countries. Secondly, maybe you could also provide some numbers of the burden of Tuberculosis in East Asian, to indicate in this way the magnitude of the double burden problem of both diabetes and tuberculosis.
Thank you for your informative blogs, I have learned a lot!
Kind regards,
Julia Schellekens
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Sorry, I meant in my comment East Africa instead of East Asia.
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Dear Julia,
Thanks for your comment, we are glad to hear you liked the blog post.
Yes, indeed there are many plans to tackle this double burden. One very effictive is for instance to screen people with diabetes for TB and vice versa. Early detection of diabetes (in combination with good diabetes management) will prevent long term complications of diabetes such as failure of the kidneys and foot ulcers.
The data on Tuberculosis you can find on: https://data.worldbank.org/indicator/SH.TBS.INCD Here you can find it of almost all countries, it is a very nice tool to compare data of countries!
Kind regards,
Joanne, Jinke, Marieke, Thom and Imke
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