International Union Against Tuberculosis and Lung Disease, Paris, France; London School of Hygiene & Tropical Medicine, London, UK.
Int J Tuberc Lung Dis. 2011 Nov;15(11):1436-44, i. doi: 10.5588/ijtld.11.0503. Epub 2011 Sep 6.
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'.
糖尿病的患病率正在以惊人的速度增长，亚洲国家，尤其是印度和中国，将首当其冲地受到这一流行病的冲击。糖尿病患者患活动性结核病（TB）的风险显著增加，是非糖尿病患者的 2 至 3 倍。在本文中，我们认为糖尿病和 TB 之间的流行病学相互作用以及对临床表现和治疗的影响与人类免疫缺陷病毒（HIV）和 TB 之间的相互作用相似。从减少 HIV 和 TB 双重负担的方法中吸取的经验教训，特别是两种疾病的筛查模式，可以加以调整并应用于糖尿病和 TB 的筛查、诊断、治疗和预防。世界卫生组织（WHO）和联盟合作框架用于 TB 和糖尿病的护理和控制与 WHO 合作活动政策有许多相似之处，旨在为政策制定者和执行者提供如何推进和应对这一迫在眉睫的双重流行的指导。尽管对即将出现的问题的规模有明确的警告，但在 20 世纪 80 年代和 90 年代，对日益严重的与 HIV 相关的结核病流行的反应缓慢且不协调。我们决不能在糖尿病和 TB 方面犯同样的错误。该框架提供了一个行动模板，现在取决于捐助者、政策制定者和执行者在实地应用这些建议，并通过“边做边学”来加以落实。
