Defining the research agenda to reduce the joint burden of disease from diabetes mellitus and tuberculosis.
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.
Harries
Anthony D
AD
International Union Against Tuberculosis and Lung Disease, Paris, France. adharries@theunion.org
Murray
Megan B
MB
Jeon
Christie Y
CY
Ottmani
Salah-Eddine
SE
Lonnroth
Knut
K
Barreto
Mauricio L
ML
Billo
Nils
N
Brostrom
Richard
R
Bygbjerg
Ib Christian
IC
Fisher-Hoch
Susan
S
Mori
Toru
T
Ramaiya
Kaushik
K
Roglic
Gojka
G
Strandgaard
Hanne
H
Unwin
Nigel
N
Viswanathan
Vijay
V
Whiting
David
D
Kapur
Anil
A
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*
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