Article Index

Introduction

Diabetes Mellitus (DM) affects 55 Million people in the Americas and its prevalence is expected to increase to 83 Million by 2030[i]. The diabetes epidemic is driven by a similar increase in the prevalence of obesity (Body Mass Index, BMI?30 Kg/m2) which is a direct consequence of hyper-caloric diet and lack of physical activity. Diabetes increases the risk of cardiovascular diseases, terminal kidney disease, blindness and amputations. People suffering from diabetes require continuous care and may face premature mortality from its complications if not managed well.

Tuberculosis (TB) continues affecting millions of people worldwide, despite the widespread availability of effective treatment for many years. In the Americas approximately 280,000 people are affected by all forms of tuberculosis every year[ii]. Most cases of tuberculosis are diagnosed in low-middle income countries and often concentrated in endemic areas with poor living conditions. The risk for tuberculosis is augmented by impaired host defense in individuals, such as those with HIV and diabetes[iii],[iv], [v]

In Mexico, the investigation of a national representative sample of 2,716 smear positive cases of TB showed that overall 22% of the total sampled cases were also persons with diagnosed diabetes[vi]. Another recent study showed that the prevalence of TB among 345 persons with diabetes under care was 1.5%, and half of them were asymptomatic cases of TB [vii]. In this study, those with diabetes were screened for tuberculosis with 3 sputum smear and monitored for diabetes control with one hemoglobin A1 (HbA1c) in Jalisco, Mexico. All cases of TB in this study were diagnosed among those with poorly controlled diabetes. A recent analysis of the impact of diabetes on the incidence of tuberculosis indicated that in India, diabetes accounted for 14.8% of cases of pulmonary tuberculosis and 20.2% of smear positive tuberculosis[viii].

Giving the rising public health importance of the DM TB co morbidity and its potential costly impact on society, PAHO conducted an analysis to better document the number of cases of TB associated with DM (TB/DM) in the Americas in 2008.