India faces a critical public health challenge: the co-occurrence of diabetes mellitus (DM) and tuberculosis (TB). A recently published paper in the prestigious Journal of Diabetes, by Dr Raju Vaishya et al. sheds light on this concerning trend, aptly termed a syndemic, demanding urgent attention. The rising prevalence of both diseases in India paints a grim picture. Type 2 diabetes is rapidly increasing across urban and rural areas, fuelled by lifestyle changes and physical inactivity. India also shoulders the global burden of TB, with millions of cases reported annually. The syndemic poses a double threat. Diabetes weakens the immune system, making individuals more susceptible to TB infection. Conversely, TB can worsen hyperglycaemia in diabetic patients, complicating management of both conditions.
The COVID-19 pandemic further exacerbated the situation. Lockdowns and disruptions in healthcare services likely led to undiagnosed TB cases and uncontrolled diabetes. New-onset diabetes due to COVID-19 has also been observed. This research paper highlights crucial gaps in our fight against the TB-DM syndemic. Limited data on the true burden and management of this co-occurrence hinders effective strategies. Additionally, a lack of robust bidirectional screening programs misses opportunities for early diagnosis and intervention. The path forward demands a multi-pronged approach. Strengthening national programs for TB and diabetes control is essential. Implementing aggressive bidirectional screening will ensure timely diagnosis of both diseases. Healthcare workers require training to manage this complex co-morbidity. Furthermore, research efforts must focus on understanding the syndemic’s epidemiology and developing effective management strategies.
India faces a significant challenge in tackling the TB-DM syndemic. Increased public health awareness, robust screening programs, improved healthcare worker training, and dedicated research are critical to combat this looming crisis. By prioritizing this syndemic, India can safeguard the health of its population and pave the way for a healthier future.
The author is the Senior Consultant, Orthopaedics and Joint Replacement, at Indraprastha Apollo Hospitals, New Delhi