Diabetes, Tuberculosis are strange bedfellows

Hyderabad: The Global Tuberculosis Report, released by the World Health Organization shows that India bears the highest burden of this disease, with 27.9 lakh patients, according to estimates collected in 2016. 

Of the estimated 27.9 lakh patients, only 19.3 lakh patients were notified in public and private hospitals. The remaining 8.5 lakh cases are still missing their treatment options. 

The global report shows that there are an estimated 10.4 million new cases of TB worldwide, of which 64 per cent of the total burden is shared by Asian and South East Asian countries. Out of these estimates, India has the highest incidence of TB.

Dr. Pramod Kumar, senior chest physician at Erragada Chest Hospital, explains, “The government has an excellent tuberculosis control program. But what is lacking is proper co-ordination by the different agencies in bringing the patient to the institutes and then following up. He said, “There is a strong need to integrate these programs and also motivate those diseased, so that they can be cured. 

“The treatment is long and requires a lot of motivation for the patients to go through it.” 

City chest physicians state that of the 10 TB patients that they see, only one or two complete their treatment on their own through self-motivation. The remaining eight have to be pushed and motivated to carry out the treatment. 

At the end of the time period, it is found that two patients have been lost with no trace of them. Another cause for the increasing TB patients is the scourge of diabetes in the country. In 45 per cent of cases, diabetes was detected first and TB later in city clinics and government hospitals. 

In about 25 per cent of the cases TB was detected first and diabetes followed. In 20 per cent of the cases diabetes and TB were detected together. Dr. Sridevi Paladugu, consultant endocrinologist at Apollo Hospitals explained, “Those who are suffering from diabetes must get their chest X-ray taken every year as it helps to diagnose TB. The growing burden of diabetes cases is also increasing the burden of TB. Both the diseases require very stringent management and often people find it difficult to cope with the tough medication regimen.” 

Another burden is that of people living with HIV whose numbers have remained stable, but who are living in  society and have to be tackled. A senior doctor on condition of anonymity explained, “People living with HIV have no option but to go to government clinics. In the private sector, these patients are not treated due to threat of infection to others. Often they require social support and that structure is missing in dealing with these patients. The numbers are not rising but they continue to remain in this category of patients and must not be undermined.” 

The burden of multi-drug resistant TB is another category where World Health Organisation has asked that apart from medical support it is important to also provide social support to these patients. There is also a need for research and innovation to deal with the resistant bacteria which is adding to the overall existing burden.