Journal Article > ResearchFull Text
Int J Tuberc Lung Dis. 2011 September 6; Volume 15 (Issue 11); DOI:10.5588/ijtld.11.0503
Harries AD, Lin YD, Satyanarayana S, Lonnroth K, Li L, et al.
Int J Tuberc Lung Dis. 2011 September 6; Volume 15 (Issue 11); DOI:10.5588/ijtld.11.0503
The prevalence of diabetes mellitus is increasing at a dramatic rate, and countries in Asia, particularly India and China, will bear the brunt of this epidemic. Persons with diabetes have a significantly increased risk of active tuberculosis (TB), which is two to three times higher than in persons without diabetes. In this article, we argue that the epidemiological interactions and the effects on clinical presentation and treatment resulting from the interaction between diabetes and TB are similar to those observed for human immunodeficiency virus (HIV) and TB. The lessons learned from approaches to reduce the dual burden of HIV and TB, and especially the modes of screening for the two diseases, can be adapted and applied to the screening, diagnosis, treatment and prevention of diabetes and TB. The new World Health Organization (WHO) and The Union Collaborative Framework for care and control of TB and diabetes has many similarities to the WHO Policy on Collaborative Activities to reduce the dual burden of TB and HIV, and aims to guide policy makers and implementers on how to move forward and combat this looming dual epidemic. The response to the growing HIV-associated TB epidemic in the 1980s and 1990s was slow and uncoordinated, despite clearly articulated warnings about the scale of the forthcoming problem. We must not make the same mistake with diabetes and TB. The Framework provides a template for action, and it is now up to donors, policy makers and implementers to apply the recommendations in the field and to 'learn by doing'.
Journal Article > CommentaryFull Text
Public Health Action. 2014 June 21; Volume 4 (Issue 2); DOI:10.5588/pha.14.0012
Kumar AMV, Satyanarayana S, Wilson N, Chadha SS, Gupta D, et al.
Public Health Action. 2014 June 21; Volume 4 (Issue 2); DOI:10.5588/pha.14.0012
Journal Article > ReviewFull Text
Public Health Action. 2013 November 4; Volume 3 (Issue 1); DOI:10.5588/pha.13.0024
Harries AD, Satyanarayana S, Kumar AMV, Nagaraja SB, Isaakidis P, et al.
Public Health Action. 2013 November 4; Volume 3 (Issue 1); DOI:10.5588/pha.13.0024
Journal Article > EditorialFull Text
Public Health Action. 2013 November 4; Volume 3 (Issue Suppl 1); S1-S2.; DOI:10.5588/pha.13.0039
Satyanarayana S, Kumar AMV, Wilson N, Kapur A, Harries AD, et al.
Public Health Action. 2013 November 4; Volume 3 (Issue Suppl 1); S1-S2.; DOI:10.5588/pha.13.0039
Journal Article > ReviewFull Text
Trans R Soc Trop Med Hyg. 2016 March 1; Volume 110 (Issue 3); DOI:10.1093/trstmh/trv111
Harries AD, Kumar AMV, Satyanarayana S, Lin YD, Zachariah R, et al.
Trans R Soc Trop Med Hyg. 2016 March 1; Volume 110 (Issue 3); DOI:10.1093/trstmh/trv111
As we enter the new era of Sustainable Development Goals, the international community has committed to ending the TB epidemic by 2030 through implementation of an ambitious strategy to reduce TB-incidence and TB-related mortality and avoiding catastrophic costs for TB-affected families. Diabetes mellitus (DM) triples the risk of TB and increases the probability of adverse TB treatment outcomes such as failure, death and recurrent TB. The rapidly escalating global epidemic of DM means that DM needs to be addressed if TB-related milestones and targets are to be achieved. WHO and the International Union Against Tuberculosis and Lung Disease's Collaborative Framework for Care and Control of Tuberculosis and Diabetes, launched in 2011, provides a template to guide policy makers and implementers to combat the epidemics of both diseases. However, more evidence is required to answer important questions about bi-directional screening, optimal ways of delivering treatment, integration of DM and TB services, and infection control. This should in turn contribute to better and earlier TB case detection, and improved TB treatment outcomes and prevention. DM and TB collaborative care can also help guide the development of a more effective and integrated public health approach for managing non-communicable diseases.
Journal Article > ResearchAbstract
Trop Med Int Health. 2012 October 1; Volume 17 (Issue 10); DOI:10.1111/j.1365-3156.2012.03068.x
Liang Li, Lin YD, Mi F, Tan S, Liang B, et al.
Trop Med Int Health. 2012 October 1; Volume 17 (Issue 10); DOI:10.1111/j.1365-3156.2012.03068.x
Objective There is a high burden of both diabetes (DM) and tuberculosis (TB) in China, and this study aimed to assess feasibility and results of screening patients with TB for DM within the routine healthcare setting of six health facilities. Method Agreement on how to screen, monitor and record was reached in May 2011 at a stakeholders' meeting, and training was carried out for staff in the six facilities in July 2011. Implementation started in September 2011, and we report on 7 months of activities up to 31 March 2012. Results There were 8886 registered patients with TB. They were first asked whether they had DM. If the answer was no, they were screened with a random blood glucose (RBG) followed by fasting blood glucose (FBG) in those with RBG ≥ 6.1 mm (one facility) or with an initial FBG (five facilities). Those with FBG ≥ 7.0 mm were referred to DM clinics for diagnostic confirmation with a second FBG. Altogether, 1090 (12.4%) patients with DM were identified, of whom 863 (9.7%) had a known diagnosis of DM. Of 8023 patients who needed screening for DM, 7947 (99%) were screened. This resulted in a new diagnosis of DM in 227 patients (2.9% of screened patients), and of these, 226 were enrolled to DM care. In addition, 575 (7.8%) persons had impaired fasting glucose (FBG 6.1 to <7.0 mm). Prevalence of DM was significantly higher in patients in health facilities serving urban populations (14.0%) than rural populations (10.6%) and higher in hospital patients (13.5%) than those attending TB clinics (8.5%). Conclusion This pilot project shows that it is feasible to screen patients with TB for DM in the routine setting, resulting in a high yield of patients with known and newly diagnosed disease. Free blood tests for glucose measurement and integration of TB and DM services may improve the diagnosis and management of dually affected patients.
Journal Article > ResearchAbstract
Trop Med Int Health. 2012 October 11; Volume 17 (Issue 12); DOI:10.1111/j.1365-3156.2012.03097.x
Khader A, Farajallah L, Shahin Y, Hababeh M, Abu-Zayed I, et al.
Trop Med Int Health. 2012 October 11; Volume 17 (Issue 12); DOI:10.1111/j.1365-3156.2012.03097.x
Objective To illustrate the method of cohort reporting of persons with diabetes mellitus (DM) in a primary healthcare clinic in Amman, Jordan, serving Palestine refugees with the aim of improving quality of DM care services. Method A descriptive study using quarterly and cumulative case findings, as well as cumulative and 12-month analyses of cohort outcomes collected through E-Health in UNRWA Nuzha Primary Health Care Clinic. Results There were 55 newly registered patients with DM in quarter 1, 2012, and a total of 2851 patients with DM ever registered on E-Health because this was established in 2009. By 31 March 2012, 70% of 2851 patients were alive in care, 18% had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow-up. Cumulative and 12-month cohort outcome analysis indicated deficiencies in several components of clinical care: measurement of blood pressure, annual assessments for foot care and blood tests for glucose, cholesterol and renal function. 10-20% of patients with DM in the different cohorts had serious late complications such as blindness, stroke, cardiovascular disease and amputations. Conclusion Cohort analysis provides data about incidence and prevalence of DM at the clinic level, clinical management performance and prevalence of serious morbidity. It needs to be more widely applied for the monitoring and management of non-communicable chronic diseases.
Journal Article > CommentaryFull Text
Int J Tuberc Lung Dis. 2015 July 19; Volume 19 (Issue 8); DOI:10.5588/ijtld.15.0069
Harries AD, Kumar AMV, Satyanarayana S, Lin YD, Zachariah R, et al.
Int J Tuberc Lung Dis. 2015 July 19; Volume 19 (Issue 8); DOI:10.5588/ijtld.15.0069
In August 2011, the World Health Organization and the International Union Against Tuberculosis and Lung Disease launched the Collaborative Framework for Care and Control of Tuberculosis (TB) and diabetes mellitus (DM) to guide policy makers and implementers in combatting the epidemics of both diseases. Progress has been made, and includes identifying how best to undertake bidirectional screening for both diseases, how to provide optimal treatment and care for patients with dual disease and the most suitable framework for monitoring and evaluation. Key programmatic challenges include the following: whether screening should be directed at all patients or targeted at those with high-risk characteristics; the most suitable technologies for diagnosing TB and diabetes in routine settings; the best time to screen TB patients for DM; how to provide an integrated, coordinated approach to case management; and finally, how to persuade non-communicable disease programmes to adopt a cohort analysis approach, preferably using electronic medical records, for monitoring and evaluation. The link between DM and TB and the implementation of the collaborative framework for care and control have the potential to stimulate and strengthen the scale-up of non-communicable disease care and prevention programmes, which may help in reducing not only the global burden of DM but also the global burden of TB.
Journal Article > ResearchFull Text
Trop Med Int Health. 2014 January 6; Volume 19 (Issue 3); DOI:10.1111/tmi.12256
Khader A, Ballout G, Shahin Y, Hababeh M, Farajallah L, et al.
Trop Med Int Health. 2014 January 6; Volume 19 (Issue 3); DOI:10.1111/tmi.12256
In a primary healthcare clinic in Jordan to determine: (i) treatment outcomes stratified by baseline characteristics of all patients with diabetes mellitus (DM) ever registered as of June 2012 and (ii) in those who failed to attend the clinic in the quarter (April-June 2012), the number who repeatedly did not attend in subsequent quarters up to 1 year later, again stratified by baseline characteristics.
Journal Article > ResearchFull Text
Trop Med Int Health. 2014 July 12; Volume 19 (Issue 10); DOI:10.1111/tmi.12356
Khader A, Farajallah L, Shahin Y, Hababeh M, Abu-Zayed I, et al.
Trop Med Int Health. 2014 July 12; Volume 19 (Issue 10); DOI:10.1111/tmi.12356
In six United Nations Relief and Works Agency (UNRWA) primary health care clinics in Jordan serving Palestine refugees diagnosed with hypertension, to determine the number, characteristics, programme outcomes and measures of disease control for those registered up to 30 June, 2013, and in those who attended clinic in the second quarter of 2013, the prevalence of disease-related complications between those with hypertension only and hypertension combined with diabetes mellitus.