The Sunday Mail
Diabetes mellitus has for a long time been perceived as a disease of the rich. Simultaneously, tuberculosis is believed to mainly affect the poor and the two epidemics where assumed to be only marginally overlapping.
Well, those assumptions are wrong. The world is facing a co-epidemic of TB-diabetes.
Diabetes is rampant in low and middle-income countries, affecting both the poor and rich alike, and increasing the risk of TB across all population segments.
The World Health Organisation has identified diabetes as a global epidemic mostly affecting low and middle-income countries where 80 percent of all deaths due to diabetes occur and about 10 percent of global TB cases are linked to diabetes.
Concurrently, TB continues to be a major cause of death worldwide despite the fact the epidemic appears to be on the verge of declining.
Diabetes triples a person’s risk of developing tuberculosis. The likelihood that a person with TB will die, or that they will get TB again after they have been successfully treated for it, is also significantly higher among people with diabetes.
Zimbabwe Diabetic Association president Dr John Mangwiro said the burden of disease due to diabetes and TB is immense.
“Unhealthy habits like smoking, alcohol abuse and consuming too much fat, salt and sugar have sparked an epidemic of diseases which together constitute the leading cause of death globally,” explained Dr Mangwiro.
“Zimbabwe is not spared as it is one of the countries heavily burdened by diabetes. As diabetes spreads, it will cause more and more people to develop TB.
“Diabetes is no longer the diseases of the wealthy. Anyone can succumb to diabetes simply because it’s a lifestyle disease.
“The diseases may not ravage a society as quickly and visibly as uncontrolled infection but its death toll is real and increasing.”
At least 210 000 people have been diagnosed of diabetes in Zimbabwe in 2015 reports the International Diabetes Federation.
According to the report, 209 800 new cases of diabetes have been diagnosed and another 149 700 undiagnosed cases have been estimated for the year 2015, raising fears that the prevalence rate of the disease estimated at 9,7 percent by the federation may be even higher. The figures represent the age groups between 20 and 79 years.
However, Zimbabwe does not have latest official statistics.
“We don’t have any official statistics, the official statistics available are for the year 2005. The IDF Atlas shows that the prevalence rate is about 10 percent of the population then,” said Dr Mangwiro.
ZDA is part of the International Diabetes Federation.
“It can, therefore, be seen that the prevalence rate of 10 percent recorded in 2005 and the estimated 9,7 recorded in 2015 shows a constant trend in the prevalence rate of diabetes in the country,” added Dr Mangwiro.
“Estimated diabetes incidences of 209 800 in only one year is a huge number which shows how serious the disease has become in the country and calls for a responsible healthy living amongst the people of Zimbabwe.”
As a result, an estimated 1,4 million Zimbabweans are diabetic.
Diabetes is escalating in countries where large numbers of people are infected with TB. Research also shows that among people being treated for TB, those with diabetes remain contagious longer than those who do not have diabetes.
TB can temporarily increase the level of blood sugar, a condition known as “impaired glucose tolerance”, which is a risk factor for developing diabetes.
Impaired glucose tolerance is also known as “pre-diabetes” because it often precedes the onset of diabetes.
“If we fail to act, the consequences could prove catastrophic for healthcare systems in areas that are impacted,” Dr Mangwiro added.
“This is largely because diabetes rates are sky-rocketing around the world and having diabetes increases the risk that a person will become ill with TB.”
Diabetes is a chronic, non-communicable disease that weakness the immune system, making people with diabetes three times more likely to get active TB. TB is an infectious disease that spreads from person to person through air. TB kills more people than any other infectious disease except HIV.
One-in-three people around the world — or two billion people — hold a latent TB infection that can remain dormant through one’s whole life.
“Diabetes is also more difficult to manage in people who have TB. And a person sick with both diseases is likely to have complications that do not typically exist when either is present on its own,” explained a health expert who agreed to speak on condition of anonymity.
Dr Mangwiro, while commenting on the regional statistics, said, “Getting statistics from other African countries, diabetes especially Type Two is on the rise, affecting an age group above 30 years especially the working class, those who can afford to eat junk food with poor nutrition, those we call euro-centric.”
The prevalence rate of diabetes in Zimbabwe has shown a constant trend of between 9,7 and 10 percent as compared with the WHO report which indicates that diabetes prevalence has quadrupled since the year 1980.
In the region, South Africa’s prevalence rate stands at 9,8 percent signifying an increase of 5 percent between the year 1980 and 2014.
In 1980, 5 percent of the population had diabetes while the figures increased to 10 percent in the year 2014.
In 2015, Zimbabwe recorded 28 556 cases of TB. And the country is one of the TB-highly burdened in Africa.
The Union and WHO in 2011 released a Collaborative Framework for Care and Control of Tuberculosis and Diabetes which provides a series of recommendations for public health policymakers and care providers.
These include providing regular bi-directional screening for the two diseases (that is screening diabetes patients for TB and screening TB patients for diabetes), administering quality assured treatment to patients suffering from both diseases and preventing TB in people with diabetes among others.
Nevertheless, Zimbabwe does not yet have statistics on the co-morbidity of diabetes and TB. The City of Harare is currently carrying out a research.
In terms of the operational policy for fighting diabetes, ZDA complements Government efforts through awareness campaigns.
“As ZDA, we complement the Government by carrying out awareness campaigns to teach people how to eat healthy and how to live well because diabetes is a disease of sedentary life, poor eating habits, over eating at night, too much starch, too much refined foods, too much 100 percent juice,” said Dr Mangwiro.
Diabetes is a chronic disease that occurs either when a pancreas does not produce enough insulin or when the body cannot effectively use the insulin that it produces. Insulin is a body hormone that regulates blood sugar.
The four risk factors which are a result of particular behaviours are tobacco use, physical inactivity, unhealthy diet and harmful use of alcohol. These are seen to cause metabolic or physiological changes.
Common symptoms of diabetes include increased urine output, excessive thirst, weight loss, hunger, fatigue, skin problems, slow healing wounds, yeast infections, blurred vision, and tingling or numbness in the feet or toes.
While coughing for more than three or more weeks, coughing up blood, chest pains, unintentional weight loss, fatigue, fever, night sweats and chills are symptoms associated with TB.
