title: The looming epidemic of diabetes-associated tuberculosis: learning lessons from HIV-associated tuberculosis.
abstract: 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'.
authors: International Union Against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene & Tropical Medicine, London, UK. adharries@theunion.org
authors: A D
authors: AD
authors: Harries
authors: Y
authors: Y
authors: Lin
authors: S
authors: S
authors: Satyanarayana
authors: K
authors: K
authors: Lönnroth
authors: L
authors: L
authors: Li
authors: N
authors: N
authors: Wilson
authors: L S
authors: LS
authors: Chauhan
authors: R
authors: R
authors: Zachariah
authors: M A
authors: MA
authors: Baker
authors: C Y
authors: CY
authors: Jeon
authors: M B
authors: MB
authors: Murray
authors: D
authors: D
authors: Maher
authors: I C
authors: IC
authors: Bygbjerg
authors: D A
authors: DA
authors: Enarson
authors: N E
authors: NE
authors: Billo
authors: A
authors: A
authors: Kapur
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D000995:Antitubercular Agents / Q000627:therapeutic use; D060085:Coinfection / Q000453:epidemiology*; D003299:Cooperative Behavior; D048909:Diabetes Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D058872:Epidemics; D014943:Global Health; D006291:Health Policy; D006801:Humans; D007391:International Cooperation; D008403:Mass Screening; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D014376:Tuberculosis / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy
chemical_list: D000995:Antitubercular Agents