Operational Handbooks

Diabetes is a chronic disease that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood glucose. Hyperglycaemia, also referred to as raised blood glucose or raised blood sugar, is a common effect of uncontrolled diabetes and, over time, leads to serious damage to many of the body’s systems, especially the nerves and blood vessels. More than 95% of people living with diabetes have type 2 diabetes, which is often preventable.

While people living with diabetes are more vulnerable to various respiratory and bacterial infections, including TB, health-care settings that provide diabetes care may have limited procedures for infection control (139). Some of the people who attend clinics that provide diabetes care will have undiagnosed TB, which may present a risk of transmission. Data are lacking on the exact time it takes to become non-infectious after effective TB treatment is commenced.

3.5.1 Eligibility for TPT

Countries are encouraged to scale up access to diabetes testing and management to reach the global targets for diagnosis and glycaemic control of diabetes as agreed at the World Health Assembly and with the aim of achieving UHC (88,89). Scale-up of diabetes services will also contribute to ending TB.

3.3.1 TB treatment regimens

If an individual with diabetes is found to have a positive TB screening result, they should receive a confirmatory diagnostic test as soon as possible. Studies suggest an association between diabetes and MDR-TB (109), and, given the increased risk of mortality in this population, it is critical that the correct TB treatment regimen be provided as early as possible once TB is diagnosed. Therefore, drug susceptibility testing is also important, in addition to establishing the diagnosis of TB disease.

3.2.1 How to diagnose TB

3.1.1 Whom to screen for TB

Screening and early diagnosis of TB among people who are at higher risk of developing TB is an important strategy for early identification of TB, for reducing morbidity and mortality due to TB and for preventing TB transmission. Systematic reviews have found that people living with diabetes are at higher risk of developing TB than people without diabetes, although people with glycaemic control are at lower risk than those with uncontrolled diabetes (2,94,95).

2.5.1 Adopt indicators and set targets for collaborative TB/DM activities.

2.4.1 Jointly develop policies, guidelines and procedures for collaborative TB/DM activities.

To implement and scale up people-centred services for TB and diabetes, programmes should jointly develop policies, guidelines and tools for collaborative action and mainstream collaborative TB/DM activities within national guidelines and SOPs.