title: Defining the research agenda to reduce the joint burden of disease from diabetes mellitus and tuberculosis.
abstract: The steadily growing epidemic of diabetes mellitus poses a threat for global tuberculosis (TB) control. Previous studies have identified an important association between diabetes mellitus and TB. However, these studies have limitations: very few were carried out in low-income countries, with none in Africa, raising uncertainty about the strength of the diabetes mellitus-TB association in these settings, and many critical questions remain unanswered. An expert meeting was held in November 2009 to discuss where there was sufficient evidence to make firm recommendations about joint management of both diseases, to address research gaps and to develop a research agenda. Ten key research questions were identified, of which 4 were selected as high priority: (i) whether, when and how to screen for TB in patients with diabetes mellitus and vice versa; (ii) the impact of diabetes mellitus and non-diabetes mellitus hyperglycaemia on TB treatment outcomes and deaths, and the development of strategies to improve outcomes; (iii) implementation and evaluation of the tuberculosis 'DOTS' model for diabetes mellitus management; and (iv) the development and evaluation of better point-of-care diagnostic and monitoring tests, including measurements of blood glucose and glycated haemoglobin A(1c) (HbA(1c)) for patients with diabetes mellitus. Implementation of this research agenda will benefit the control of both diseases.
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France. adharries@theunion.org
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Harries
authors.forename: Megan B
authors.initials: MB
authors.lastname: Murray
authors.forename: Christie Y
authors.initials: CY
authors.lastname: Jeon
authors.forename: Salah-Eddine
authors.initials: SE
authors.lastname: Ottmani
authors.forename: Knut
authors.initials: K
authors.lastname: Lonnroth
authors.forename: Mauricio L
authors.initials: ML
authors.lastname: Barreto
authors.forename: Nils
authors.initials: N
authors.lastname: Billo
authors.forename: Richard
authors.initials: R
authors.lastname: Brostrom
authors.forename: Ib Christian
authors.initials: IC
authors.lastname: Bygbjerg
authors.forename: Susan
authors.initials: S
authors.lastname: Fisher-Hoch
authors.forename: Toru
authors.initials: T
authors.lastname: Mori
authors.forename: Kaushik
authors.initials: K
authors.lastname: Ramaiya
authors.forename: Gojka
authors.initials: G
authors.lastname: Roglic
authors.forename: Hanne
authors.initials: H
authors.lastname: Strandgaard
authors.forename: Nigel
authors.initials: N
authors.lastname: Unwin
authors.forename: Vijay
authors.initials: V
authors.lastname: Viswanathan
authors.forename: David
authors.initials: D
authors.lastname: Whiting
authors.forename: Anil
authors.initials: A
authors.lastname: Kapur
mesh_terms: D048909:Diabetes Complications / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D006302:Health Services Research / Q000458:organization & administration*; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration; D016730:Program Development; D016896:Treatment Outcome; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*
references.citation: Lancet Infect Dis. 2009 Dec;9(12):737-46
references.pmid: 19926034
references.citation: PLoS Med. 2008 Jun 10;5(6):e124
references.pmid: 18547138
references.citation: Z Tuberk. 1958;111(3-4):167-73
references.pmid: 13604793
references.citation: Chronic Illn. 2007 Sep;3(3):228-45
references.pmid: 18083679
references.citation: BMC Public Health. 2007 Sep 06;7:234
references.pmid: 17822539
references.citation: Lancet Infect Dis. 2010 Feb;10(2):93-102
references.pmid: 20113978
references.citation: PLoS Med. 2008 Jul 15;5(7):e152
references.pmid: 18630984
references.citation: Trans R Soc Trop Med Hyg. 2009 Jun;103(6):537-40
references.pmid: 19155031
references.citation: JAMA. 2008 Jul 23;300(4):423-30
references.pmid: 18647985
references.citation: Int J Tuberc Lung Dis. 2006 Jan;10(1):93-8
references.pmid: 16466044
references.citation: Int J Tuberc Lung Dis. 1999 May;3(5):445-50
references.pmid: 10331735
references.citation: Trop Doct. 2006 Apr;36(2):71-3
references.pmid: 16611436
references.citation: Probl Tuberk. 1969;47(12):1-3
references.pmid: 5392498