The global dynamics of diabetes and tuberculosis: the impact of migration and policy implications.
The convergence between tuberculosis (TB) and diabetes mellitus (DM) will represent a major public health challenge in the near future. DM increases the risk of developing TB by two to three times and also increases the risk of TB treatment failure, relapse, and death. The global prevalence of DM is predicted to rise significantly in the next two decades, particularly in some of the low- and middle-income countries with the highest TB burden. Migration may add further complexity to the effort to control the impact on TB of the growing DM pandemic. Migration may increase the risk of DM, although the magnitude of this association varies according to country of origin and ethnic group, due to genetic factors and lifestyle differences. Migrants with TB may have an increased prevalence of DM compared to the native population, and the risk of TB among persons with DM may be higher in migrants than in autochthonous populations. Screening for DM among migrants, screening migrants with DM for active and latent TB, and improving access to DM care, could contribute to mitigate the effects of DM on TB.
National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Via Portuense 292, 00149 Rome, Italy.
Enrico
E
Girardi
National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Via Portuense 292, 00149 Rome, Italy.
Monica
M
Sañé Schepisi
National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Via Portuense 292, 00149 Rome, Italy.
Delia
D
Goletti
Division of Infection and Immunity, University College London; and National Institute of Health Research Biomedical Research Centre at UCL Hospitals, London, UK; UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia.
Matthew
M
Bates
UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia.
Peter
P
Mwaba
Department of Bacteriology, Noguchi Memorial Institute for Medical Research, Accra, Ghana.
Dorothy
D
Yeboah-Manu
Fondation Congolaise pour la Recherche Médicale, Faculté des Sciences de la Santé, Marien Ngouabi University; and Faculté des Sciences et Techniques, Marien Ngouabi University, Brazzaville, Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany.
Francine
F
Ntoumi
National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Via Portuense 292, 00149 Rome, Italy.
Fabrizio
F
Palmieri
Therapeutic Immunology (TIM) Division, Department of Laboratory Medicine, Karolinska University Hospital Huddinge; and Centre for Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Markus
M
Maeurer
Division of Infection and Immunity, University College London; and National Institute of Health Research Biomedical Research Centre at UCL Hospitals, London, UK; UNZA-UCLMS Research and Training Program, University Teaching Hospital, Lusaka, Zambia; International Public Health Crisis Group (IPHCG), London, United Kingdom - Rome, Italy.
Alimuddin
A
Zumla
National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Via Portuense 292, 00149 Rome, Italy; International Public Health Crisis Group (IPHCG), London, United Kingdom - Rome, Italy. Electronic address: giuseppe.ippolito@inmi.it.
Giuseppe
G
Ippolito
D003920:Diabetes Mellitus / Q000453:epidemiology*; D005544:Forecasting; D063426:Human Migration; D006801:Humans; D015995:Prevalence; D011634:Public Health; D011640:Public Policy; D014397:Tuberculosis, Pulmonary / Q000453:epidemiology*
Communicable diseases; Diabetes; Migrants; Tuberculosis