Defining the research agenda to reduce the joint burden of disease from diabetes mellitus and tuberculosis

TY - JOUR

T1 - Defining the research agenda to reduce the joint burden of disease from diabetes mellitus and tuberculosis

AU - Harries, Anthony D

AU - Murray, Megan B

AU - Jeon, Christie Y

AU - Ottmani, Salah-Eddine

AU - Lonnroth, Knut

AU - Barreto, Mauricio L

AU - Billo, Nils

AU - Brostrom, Richard

AU - Bygbjerg, Ib Christian

AU - Fisher-Hoch, Susan

AU - Mori, Toru

AU - Ramaiya, Kaushik

AU - Roglic, Gojka

AU - Strandgaard, Hanne

AU - Unwin, Nigel

AU - Viswanathan, Vijay

AU - Whiting, David

AU - Kapur, Anil

PY - 2010/6/1

Y1 - 2010/6/1

N2 - 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.

AB - 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.

KW - Diabetes Complications

KW - Diabetes Mellitus

KW - Health Services Research

KW - Humans

KW - Mass Screening

KW - Program Development

KW - Treatment Outcome

KW - Tuberculosis

U2 - 10.1111/j.1365-3156.2010.02523.x

DO - 10.1111/j.1365-3156.2010.02523.x

M3 - Journal article

C2 - 20406430

SN - 1360-2276

VL - 15

SP - 659

EP - 663

JO - Tropical Medicine & International Health

JF - Tropical Medicine & International Health

IS - 6

ER -