Diabetes, TB: Can looming co-epidemic be averted?
Having developed constant fatigue, excessive thirst, weight loss, fevers and night sweats, Mr Ngoni Mapuranga (53) who resides in Marondera reluctantly avoided going to the hospital under the pretext that it will pass.
WHEN the condition failed to abate, he started taking remedies prescribed by local medicine men, but the fevers and night sweats did not subside. “It began with symptoms which were flu-like and this went on for a year. I took natural herbs, and sometimes would feel well, but the symptoms were uncomfortable and didn’t go away,” said Mr Mapuranga.
“However, I was soon experiencing tiredness and dizziness, which I thought was weird.”
A trip to the emergency room and a chest X-ray indicated tuberculosis (TB).
“I was afraid to visit the hospital,” Mr Mapuranga said.
“I thought it was only a fever and due to the nature of my job as a welder, it is common that one develops a fever time and again.
“I was hospitalised for close to two weeks at Marondera hospital.
“By this time I had fluid in my lungs and stomach, and had an enlarged liver.”
Difficult as it seemed for Mr Mapuranga, suffering from a highly transmittable disease made him face stigma.
“The most difficult part was being treated like an outcast by some relatives fearing I would spread the disease,” he added.
“Whenever people came to visit me, hospital staff would give them masks.”
As if that was not enough, Mr Mapuranga was dealt with another blow as his blood tests indicated that he had diabetes mellitus (DM).
Though the discovery was made after it had caused numbness on his right toes-he did not lose hope.
Mr Mapuranga was not surprised by the development as his family has a long standing history of the metabolic disorder.
Fortunately for Mr Mapuranga his health situation was able to improve as taking his TB medicines religiously eventually cured him of the disease.
According to health experts, TB can temporarily increase the level of blood sugar, a condition known as “impaired glucose tolerance’ which is a risk factor for developing diabetes.
City of Harare Director of Health Services, Dr Prosper Chonzi said diabetic people have an immune system that is vulnerable to infections.
“Diabetic people are at high risk of being susceptible to various infections because they have a suppressed immune system,” said Dr Chonzi.
Dr Chonzi added that TB patients with DM must note that even when they are cleared of TB, they have to continue taking DM medication because it is lifelong treatment.
“Patients may get tired of taking the pills as a result of pill fatigue and it can occur either when a patient is feeling much better or else develops side effects from taking the medication,” he said.
According to Dr Chonzi diabetes is fuelling the spread of TB and this negatively impacts on global efforts to end TB by 2035.
“The drug interactions between diabetes and TB medication can also have negative implications,” said Dr Chonzi.
World Health Organisation (WHO) notes that DM increases the risk of TB by two to three times.
WHO has identified diabetes as a global epidemic mostly affecting low and middle income countries where 80 percent of all deaths due to diabetes occur and about 10 percent of global TB cases are linked to diabetes.
Concurrently, TB continues to be a major cause of death worldwide despite the fact the epidemic appears to be on the verge of declining.
International Union Against Tuberculosis and Lung Disease (The Union) country director, Dr Christopher Zishiri explained the TB-diabetes co-morbidity.
“Due to the fact that DM weakens the immune system, one is vulnerable to a series of infections. DM triples the risk of developing TB,” said Dr Zishiri
“TB and DM are two of the world’s leading causes of death and disability.”
Dr Zishiri added that the two infections have to be taken seriously because the combination could be deadly.
“Patients with TB-diabetes co-morbidity are at an increased risk of TB relapse, treatment failure and death,” he explained.
“They also have challenges in controlling their blood sugar levels thus increasing the likelihood of developing complications from DM.
“Diabetic patients also experience some gastro-paresis which impairs absorption of a number of TB drugs.”
Nevertheless, Zimbabwe does not yet have statistics on the co-morbidity of diabetes and TB as City of Harare is currently carrying out a research.
To date, The Union Zimbabwe Office and Uganda Office have embarked on a pilot programme on 10 health facilities from each country as a measure to have a two-way approach on TB and diabetes.
In Zimbabwe, the pilot programme is currently running at Mabvuku, Glenview, Buduriro, Mufakose, Kuwadzana, Rujeko, Warren Park, Mbare, Rutsanana and Highfield polyclinics.
Ministry of Health and Child Care’s Deputy Director of AIDS and TB Unit, Dr Charles Sandy said that TB infection may lead to metabolic changes that make management of sugar in a diabetic person hard.
“Co-infection may lead to poor outcomes for the patient if both conditions are not well managed for example diabetes complications, failure of ant-TB treatment and even death.” said Dr Sandy.
Zimbabwe being one of the TB-highly burdened countries in Africa recorded 28 556 cases in 2015 (Ministry of Health and Child Care statistics).
In the same year, at least 210 000 people in Zimbabwe were diagnosed with diabetes as reported by the International Diabetes Federation (IDF).
Unlike TB, diabetes is not contagious, and there is no cure in the vast majority of cases, patients therefore manage the illness over the course of a lifetime.
In 2011, The Union and WHO released a Collaborative Framework for Care and Control of Tuberculosis and Diabetes provided a series of recommendations for public health policymakers and care providers.
These include providing regular bi-directional screening for the two diseases (that is screening diabetes patients for TB and screening TB patients for diabetes); administering quality assured treatment to patients suffering from both diseases and preventing TB in people with diabetes among others.
Zimbabwe Diabetic Association (ZDA) president Dr John Mangwiro said the burden of disease due to diabetes and TB is immense.
“Diabetes is quietly fuelling the spread of TB, said Dr Mangwiro.
“Diabetes is more difficult to manage in people who have TB. And a person sick with both diseases is likely to have complications that do not typically exist when either is present on its own,” explained Dr Mangwiro.
Through the End TB strategy instigated by WHO, the world is committed to achieve an 80 percent decline in TB incidence by 2030 as compared to 2015 but this cannot be achieved if DM diagnosis and treatment is not accelerated.