Operational Handbooks

Annex 3. Criteria for referral to higher levels of care

Urgent (same day) referral should be assured if one of the following is detected:
  • urine ketones ≥ 2 or no improvement in glycaemia ≥ 18 mmol/L after management with metformin and/or gliclazide;
  • suspicion of ketoacidosis or hyperosmolar hyperglycaemic state;
  • hypoglycaemia unresolved by treatment;
  • clinical suspicion of type 1 diabetes in a newly diagnosed patient;
  • symptoms or signs of coronary heart disease and stroke;
  • recent deterioration of vision;
  • blood pressure > 200/> 110 mm Hg
  • blood pressure >

Annex 1. Summary of declaration of interests

Evidence reviewers

Kenneth G Castro declared receiving ongoing funding from USAID to serve as Senior TB Scientific Advisor (80% level of effort), from the National Institutes of Health to serve as Associate Director Emory-Georgia TB Research Advancement Center (10% level of effort), and from the US Department of State, Bureau of Education and Cultural Affairs, to serve as Coordinator of the Emory Hubert H. Humphrey Fellowship Program (10% level of effort).

4. Reduce the burden of diabetes among people with TB.

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.

3.6 TB IPC in clinics that provide diabetes care

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.