Defining a research agenda to address the converging epidemics of tuberculosis and diabetes. Part 1: Epidemiology and clinical management

There is growing interest in the interaction between type 2 diabetes (DM) and tuberculosis (TB), but many research questions remain unanswered. Epidemiologists, basic scientists and clinical experts recently convened and identified priorities. This is the first of two reviews on this topic, summarising priority areas of research with regard to epidemiology, clinical management and public health. First, from an epidemiological point of view, more study is needed to determine the importance of transient hyperglycemia in TB patients, and on the importance of DM for the global epidemic of multi-drug resistant (MDR)-TB. Second, with regard to screening and clinical management of combined TB-DM, clinical trials and large cohort studies should examine the benefits of improved DM care as well as prolonged or intensified TB treatment to the outcome of TB-DM, and investigate cost-effectiveness of screening methods for DM among newly diagnosed TB patients. Third, from a public health and health systems point of view, the population health impact and cost-effectiveness of different interventions to prevent or treat DM and TB in high burden populations should be examined, and health systems interventions should be developed for routine TB-DM screening, management of DM after TB treatment completion, and better access to DM services worldwide. Studies are needed across different ethnicities and settings given the heterogeneity of metabolic perturbations, inflammatory responses, medications, and access to health care. Finally, studies should address interactions between TB, DM and HIV, because of the convergence of epidemics in sub-Saharan Africa and some other parts of the world.

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