39 research outputs found
Nutrition, diabetes and tuberculosis in the epidemiological transition
No full textThe original publication is available at http:/www.plosone.orgBackground: Diabetes prevalence and body mass index reflect the nutritional profile of populations but have opposing effects on tuberculosis risk. Interactions between diabetes and BMI could help or hinder TB control in growing, aging, urbanizing populations. Methods and Findings: We compiled data describing temporal changes in BMI, diabetes prevalence and population age structure in rural and urban areas for men and women in countries with high (India) and low (Rep. Korea) TB burdens. Using published data on the risks of TB associated with these factors, we calculated expected changes in TB incidence between 1998 and 2008. In India, TB incidence cases would have increased (28% from 1.7 m to 2.1 m) faster than population size (22%) because of adverse effects of aging, urbanization, changing BMI and rising diabetes prevalence, generating an increase in TB incidence per capita of 5.5% in 10 years. In India, general nutritional improvements were offset by a fall in BMI among the majority of men who live in rural areas. The growing prevalence of diabetes in India increased the annual number of TB cases in people with diabetes by 46% between 1998 and 2008. In Korea, by contrast, the number of TB cases increased more slowly (6.1% from 40,200 to 42,800) than population size (14%) because of positive effects of urbanization, increasing BMI and falling diabetes prevalence. Consequently, TB incidence per capita fell by 7.8% in 10 years. Rapid population aging was the most significant adverse effect in Korea. Conclusions: Nutritional and demographic changes had stronger adverse effects on TB in high-incidence India than in lower-incidence Korea. The unfavourable effects in both countries can be overcome by early drug treatment but, if left unchecked, could lead to an accelerating rise in TB incidence. The prevention and management of risk factors for TB would reinforce TB control by chemotherapy. © 2011 Dye et al
Global Guideline for Type 2 Diabetes
No full textThere is now extensive evidence on the optimal management of diabetes, offering the opportunity of improving the immediate and long-term quality of life of those with diabetes. Unfortunately such optimal management is not reaching many, perhaps the majority, of the people who could benefi t. Reasons include the size and complexity of the evidencebase, and the complexity of diabetes care itself. One result is a lack of proven cost-effective resources for diabetes care. Another result is diversity of standards of clinical practice. Guidelines are one part of a process which seeks to address those problems. Many guidelines have appeared internationally, nationally, and more locally in recent years, but most of these have not used the rigorous new guideline methodologies for identifi cation and analysis of the evidence. Many countries around the world do not have the resources, either in expertise or fi nancially, that are needed to develop diabetes guidelines. Also such a repetitive approach would be enormously ineffi cient and costly. Published national guidelines come from relatively resource-rich countries, and may be of limited practical use in less well resourced countries. In 2005 the fi rst IDF Global Guideline for type 2 diabetes was developed. This presented a unique challenge as we tried to develop a guideline that is sensitive to resource and costeffectiveness issues. Many national guidelines address one group of people with diabetes in the context of one healthcare system, with one level of national and health-care resources. This is not true in the global context where, although every health-care system seems to be short of resources, the funding and expertise available for health-care vary widely between countries and even between localities. Despite the challenges, we feel that we found an approach which is at least partially successful in addressing this issue which we termed ‘Levels of care’ (see next page). This guideline represents an update of the fi rst guideline and extends the evidence base by including new studies and treatments which have emerged since the original guideline was produced in 2005. Funding is essential to an activity of this kind. IDF is grateful to a diversity of commercial partners for provision of unrestricted educational grants.Fil: Aschner, Pablo. International Diabetes Federation Guideline Development Group; BélgicaFil: Beck Nielsen, Henning. International Diabetes Federation Guideline Development Group; BélgicaFil: Bennet, Peter. International Diabetes Federation Guideline Development Group; BélgicaFil: Boulton, Andrew. International Diabetes Federation Guideline Development Group; BélgicaFil: Colagiuri, Ruth. International Diabetes Federation Guideline Development Group; BélgicaFil: Colagiuri, Stephen. International Diabetes Federation Guideline Development Group; BélgicaFil: Franz, Marion. International Diabetes Federation Guideline Development Group; BélgicaFil: Gadsby, Roger. International Diabetes Federation Guideline Development Group; BélgicaFil: Gagliardino, Juan Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Cientifico Tecnológico La Plata. Centro de Endocrinologia Experimental y Aplicada (i); Argentina. Universidad Nacional de La Plata; Argentina. International Diabetes Federation Guideline Development Group; BélgicaFil: Home, Philip. International Diabetes Federation Guideline Development Group; BélgicaFil: McGill, Marg. International Diabetes Federation Guideline Development Group; BélgicaFil: Manley, Susan. International Diabetes Federation Guideline Development Group; BélgicaFil: Marshall, Sally. International Diabetes Federation Guideline Development Group; BélgicaFil: Mbanya, Jean Claude. International Diabetes Federation Guideline Development Group; BélgicaFil: Neil, Andrew. International Diabetes Federation Guideline Development Group; BélgicaFil: Ramachandran, Ambady. International Diabetes Federation Guideline Development Group; BélgicaFil: Ramaiya, Kaushik. International Diabetes Federation Guideline Development Group; BélgicaFil: Roglic, Gojka. International Diabetes Federation Guideline Development Group; BélgicaFil: Schaper, Nicolaas. International Diabetes Federation Guideline Development Group; BélgicaFil: Siminerio, Linda. International Diabetes Federation Guideline Development Group; BélgicaFil: Sinclair, Alan. International Diabetes Federation Guideline Development Group; BélgicaFil: Snoek, Frank. International Diabetes Federation Guideline Development Group; BélgicaFil: Van Crombrugge, Paul. International Diabetes Federation Guideline Development Group; BélgicaFil: Vespasiani, Giacomo. International Diabetes Federation Guideline Development Group; BélgicaFil: Viswanathan, Vijay . International Diabetes Federation Guideline Development Group; Bélgic
Diabetes and tuberculosis: the impact of the diabetes epidemic on tuberculosis incidence.
No full textBACKGROUND: Tuberculosis (TB) remains a major cause of mortality in developing countries, and in these countries diabetes prevalence is increasing rapidly. Diabetes increases the risk of TB. Our aim was to assess the potential impact of diabetes as a risk factor for incident pulmonary tuberculosis, using India as an example. METHODS: We constructed an epidemiological model using data on tuberculosis incidence, diabetes prevalence, population structure, and relative risk of tuberculosis associated with diabetes. We evaluated the contribution made by diabetes to both tuberculosis incidence, and to the difference between tuberculosis incidence in urban and rural areas. RESULTS: In India in 2000 there were an estimated 20.7 million adults with diabetes, and 900,000 incident adult cases of pulmonary tuberculosis. Our calculations suggest that diabetes accounts for 14.8% (uncertainty range 7.1% to 23.8%) of pulmonary tuberculosis and 20.2% (8.3% to 41.9%) of smear-positive (i.e. infectious) tuberculosis. We estimate that the increased diabetes prevalence in urban areas is associated with a 15.2% greater smear-positive tuberculosis incidence in urban than rural areas - over a fifth of the estimated total difference. CONCLUSION: Diabetes makes a substantial contribution to the burden of incident tuberculosis in India, and the association is particularly strong for the infectious form of tuberculosis. The current diabetes epidemic may lead to a resurgence of tuberculosis in endemic regions, especially in urban areas. This potentially carries a risk of global spread with serious implications for tuberculosis control and the achievement of the United Nations Millennium Development Goals
