Diabetics should be on guard against the risks of TB

2017-04-13 06:00
Goodman Mkhanda lives with both TB and diabetesPHOTO: Kim Harrisberg

Goodman Mkhanda lives with both TB and diabetesPHOTO: Kim Harrisberg

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Diabetics should be careful to protect themselves from TB, explains this Khayelitsha man who is living with both conditions.

HIV is known to fuel tuberculosis (TB), but the lesser-known threat of diabetes actually places people at greater risk of getting sick with TB. Screening people with TB for diabetes is advised in the national guidelines, but does not happen routinely in practice.

At the age of 27, Goodman Mkhanda was diagnosed with type 2 diabetes. At 31, he was told he had tuberculosis (TB). A few days later his local clinic in Khayelitsha, outside Cape Town, called him to tell him he had multi-drug-resistant TB (MDR-TB).

“I thought diabetes was for old people but when my mom told me she had it, it made sense because it is passed down in families. But the TB, I was truly shocked,” the energetic man told Health-e News, from the Doctors Without Borders’ (MSF) station on the outskirts of Khayelitsha.

But he shouldn’t have been. Although most people know that living with HIV, because it weakens the immune system, increases your risk for developing TB, most people don’t know that diabetes does the same.

Risk: Diabetes versus HIV

According to a 2014 report in the Lancet Diabetes and Endocrinology medical journal, diabetes is directly responsible for 15 percent of all tuberculosis cases worldwide, because it weakens the immune system.

“Patients with concurrent diabetes suffer worse tuberculosis treatment outcomes, a higher rate of relapse following tuberculosis treatment, and a higher risk of death from tuberculosis than patients with tuberculosis alone,” noted the authors.

The World Health Organisation (WHO) estimated that in 2015 there were 11 percent of new TB cases who were living with HIV.

MSF’s Dr Jenny Hughes, who works with TB patients in Khayelitsha, said that diabetes, in fact, is a higher risk factor for developing TB than even HIV.

“Having diabetes increases your risk for TB by at least threefold compared to patients without diabetes. Patients with poorly controlled diabetes or those on insulin are at even higher risk of getting sick with TB,” she said.

TB and diabetes are both killers

But, she said, there is very little data on TB and diabetes from Africa specifically, making the true burden of the co-epidemic in South Africa largely unknown.

This month Health-e News reported that diabetes is now the biggest killer of South African women and the second biggest killer overall, according to the 2015 death statistics released recently by Statistics South Africa. And TB was the leading killer in men.

Mkhanda himself thought he must have HIV and was surprised when he tested HIV-negative.

“Only then did I find out that TB is a common disease for diabetics,” he said.

Treating the two conditions is already difficult but in March 2014 things got worse.

Although he had endured with pain the daily treatment for MDR-TB, which consists of daily painful injections and a cocktail of oral drugs, for months, he did not get better.

DR-TB and toxic drugs

He was told he had extensively-drug resistant TB (XDR-TB) and he would have to change medications.

According to the WHO, MDR-TB is resistant to two of the most effective anti-TB drugs and has a cure rate of about 50 percent. XDR-TB is resistant to four of the most effective anti-TB drugs but only about a quarter of patients are cured.

Both involve around two years of treatment with toxic drugs with serious side-effects including deafness.

Diabetes develops when the level of sugar (glucose) in a person’s blood is abnormally high. Over time, the high level of glucose in a person’s bloodstream damages the blood vessels, causing strokes, heart attacks, blindness, kidney failure and nerve damage that can lead to amputations.

Although Mkhanda was offered access to one of few new anti-TB drugs on the market, bedaquiline, he still did not get better.

Three years later, he has been offered another new anti-TB drug, has had an operation on his lung and is still on treatment.

“I am finally feeling better but I have to take my medication for about one more year and then I can say that I have been cured,” he said.

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