Coordination needed against TB - Diabetes tandem - study

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The Philippines is not prepared to detect and prevent the complications, including resistance to treatment, posed by the tandem of tuberculosis (TB) and diabetes mellitus (DM).

Researchers of state think-tank Philippine Institute for Development Studies (PIDS), led by Dr. Emmanuel S. Baja, urge national health agencies to work together to initiate research studies and produce a coordinated response to detect, prevent, and manage the deadly TB-DM tandem in a study released by PIDS. The output of Baja’s study is part of the Health System Research Management Project of the PIDS and the Department of Health (DOH).

The International Diabetes Foundation stated in their 2014 report that people with diabetes are prone to contracting tuberculosis. In countries where there is a rising rate of diabetes, there is an alarming and significantly matching spike in tuberculosis. The compounded infection makes it hard for patients with both TB and DM to respond to treatment.

The World Health Organization in 2011 reported that TB patients who are diagnosed with diabetes have a higher mortality risk.

At present, the Philippines is ranked 15 as an emerging diabetes hotspot. At the same time, the country also has one of the highest notified cases of multidrug resistant TB.
To understand the current state of health programs to address the TB-DM tandem, the PIDS research team surveyed the level of awareness and vigilance among medical practitioners to test TB patients for DM and vice versa.

Majority of surveyed physicians could adequately identify observable symptoms, and correctly answered questions about diagnostic tests for either disease. However, less than half appeared confident about the prevalence and risks of contracting both disease.

More than two thirds do agree that screening for TB in DM patients and DM in TB patients should be performed. About a half of them agree that a TB-DM tandem presents difficulties in treatment.

Focus group discussions with the staff of the National TB Control Program (NTBCP) and the Degenerative Diseases Office (DDO) of the DOH were conducted to determine the current level of coordinated action to control and prevent the TB-DM tandem, as well as evaluate the costs of bidirectional screening.

The study found the lack of consensus among the staff of these agencies on how to address the TB-DM, despite the 2011 WHO recommendation for countries with high rates of either disease to pay attention to the “double burden of disease and the need for joint surveillance, coordinated referral and management systems, a joint research agenda”.

The study also revealed that the DDO staff believed that screening for TB-DM is important and challenging, but they didn’t necessarily view the tandem as a public health issue.

However, the NTBCP disagreed that prevalence of DM in TB patients is an extensive problem, and underlined the concerns that TB diagnosis might stigmatize DM patients. 

The study recommends a pilot study on the tandem disease. The current lack of initiative to detect it could be related to the lack of information to guide the change in detection policies.

The costly implementation of bidirectional screening, especially screening TB in DM patients, also compounds the issue.

The PIDS-DOH study strengthens the argument for a more informed study on the issue. It states, “Given the government’s commitment to the nationwide control of TB, the underexplored frontier of TB among diabetic patients can be among the stretch goals towards increased case detection, management and prevention efforts.”

The national agencies overseeing the care and control of TB and DM need to cooperate to increase awareness among health workers and the general public about the prevalence and risks of the tandem disease.   They have to coordinate their respective policies, programs, and operations, including bidirectional screening, to detect and manage it. 

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