Prevalence of Tuberculosis and Diabetes

Tuberculosis (TB) is one of the leading causes of death worldwide and, although great efforts have already been made, the way to defeat this disease is still long [1]. The burden of TB is higher in Sub-Saharan Africa and low income countries where, another increasing plague, the diabetes mellitus (DM) is affecting more and more people. The rapid increase of DM and its coexistence with TB and HIV is a clear example of overlap and interaction between communicable and noncommunicable diseases requiring a multidisciplinary and integrated approach [2]. The association between TB and DM, in particular in low and medium income countries, has been showed to cause a mutual worsening of the natural history of both diseases. Although the pathophysiological mechanism is still unclear, it has been observed that each disease may adversely affect the outcomes of the other, in terms of delayed diagnosis and healing, severity of symptoms, mortality [2]. However, to date, contrasting data are available regarding TB prevalence in diabetes and vice versa and, recent findings suggest a high burden of diabetes among TB patients but low prevalence of TB among DM patients [3]. Apparently, this is a contrast that could be partially explained by social determinants of health (SDH). In fact, growing evidence suggests that the lack of efficacy in containing TB and the presence of multi drug resistance (MDR), is due to many factors including SDH [4]. SDH are defined as conditions in which people are born, grow, live, work and get old having an immediate impact on health and are greatly influenced by the distribution of money, power and resources [5]. In particular, low education, low income and alcohol abuse are significant predictors of therapy failure and MDR in people with TB.