India’s diabetes epidemic is making its widespread TB problem worse

Subject : Science and technology

Section: Health

Concept :

India has been experiencing the double burden of two debilitating and severe epidemics – type 2 diabetes (a.k.a. diabetes mellitus, DM) and tuberculosis (TB). The figures for both are staggering.
Currently, India has around 74.2 million people living with diabetes while TB affects 2.6 million Indians every year. Yet few know how deeply these diseases are interlinked.

How do DM and TB ‘work’ together?

DM not only increases the risk of TB, it also delays the sputum smear and culture conversion of an individual affected by both diseases.
In other words, reducing the number of TB bacteria to below the threshold required to claim they have ‘healed’ will take longer than usual.
DM impairs cell-mediated immunity; uncontrolled DM affects the cytokine response and alters the defences in the alveolar macrophages.
The altered functions of small blood vessels in the lung (due to hyperglycaemia) along with poor nutritional status may facilitate the invasion and establishment of TB.
Aspeople with diabetes have already compromised immune function, the risk of TB infection is high. They will also have a higher bacterial load.
A study revealed that the TB-DM group showed reduced lung functioning after TB treatment completion compared to the TB non-DM group. There was a greater improvement in radiographic scores among people with TB non-DM compared to DM.
DM also increases the likelihood of unfavourable TB treatment outcomes, such as treatment failure, relapse/reinfection, and even death. So people with DM and TB suffer more severely and must fight harder to survive

How does DM affect people with TB?

In individuals affected by both diseases, the lungs are severely affected (in studies, researchers have observed multiple and large lung cavities).
Persistent inflammation has also been seen in people with DM and TB – even after they have completed their TB treatment, speaking to the combined impact of these diseases even after a ‘cure’.
Also, This indicates that one’s nutritional status is important for favourable TB treatment outcomes.
The most common cause of deaths were respiratory complications (50%) followed by events related to cardiovascular disease (32%) in those affected with TB DM as compared to TB only (27% and 15%).

About Diabetes

Diabetes is a chronic issue that can lead to complications like cardiovascular diseases, kidney disease, neuropathy, blindness etc. Hence it becomes crucial to keep it away.
Diabetes mellitus is a metabolic disease of high blood sugar (glucose) levels that result from problems with insulin secretion, its action, or both. Normally, blood glucose levels are tightly controlled by a hormone produced by the pancreas known as insulin.
When blood glucose levels rise (for example, after eating food), insulin is released from the pancreas to normalize the glucose level.

Type 1 diabetes:

An absolute lack of insulin, usually due to destruction of the insulin-producing beta cells of the pancreas, is the main problem in type 1 diabetes.
It is to be due to an autoimmune process, in which the body’s immune system mistakenly targets its own tissues (islet cells in the pancreas. This tendency for the immune system to destroy the beta cells of the pancreas is likely to be, at least in part, genetically inherited, although the exact reasons that this process happens are not fully understood.

Type 2 diabetes:

People who have type 2 diabetes can still produce insulin, but do so relatively inadequately for their body’s needs.
Genetics plays a role in the development of type 2 diabetes, and having a family history and close relatives with the condition increases your risk; however, there are other risk factors, with obesity being the most significant.