Time is now to review diabetic clinical care

Irene Andia Biraro

What you need to know:

  • Disease not curable. Diabetes weakens the body’s immunity similar to other diseases such as HIV and cancer. In addition, diabetes is not curable and often people need to take medicine for the rest of their lives. If one does not take their medicines, it can cause them more harm, including having more risk of acquiring TB.

The world commemorated the World Diabetes Day on November 14, with emphasis on the “family and diabetes.” As a physician working at one of Uganda’s public hospitals, my heartfelt empathy goes out to more than one million diabetic patients and their families living in Uganda. These brave souls have to deal with this disease daily over their lifetimes. They face many complications with their kidneys, heart, eyes, nerves to name a few. But there is complication that has been silent over the years and is now emerging as a force to reckon with; the notorious disease called tuberculosis (TB).

Diabetics are at a high risk of being infected with TB. Every three out of 10 patients with diabetes will present with active TB disease. The diabetics that get TB have been shown to have higher chances of dying from their TB disease compared to those with the individual diseases - their TB disease takes longer to get cured, they have problems getting their blood sugar levels controlled, and generally have much poorer quality of life.

This is probably not news to many people, so why should it matter now? Some may argue that we have known since days of old that TB disease is a known complication of diabetes. So why the hype now? What has changed?
Numbers! On one hand, the numbers of diabetics have tripled or quadrupled and on the other, there is the rising number of TB cases in our communities, which has increased the risk of getting TB. In fact, many people with TB disease are missed!
The other thing that has changed is the geographical and socio-economic distribution of diabetes disease. In the clinic setting, we are seeing many rural folks developing diabetes.

Many “poor” Ugandans are getting diabetes because of the rising poor lifestyle habits. Many Ugandans are eating more unhealthy foods high in sugar and unsaturated fats from the growing fast food places, but also from street vendors, including the famous “Rolex”. Many are having less active lives, and most cannot afford routine medical checkups that help catch diabetes disease early. Therefore, unfortunately, by the time it is detected, the diabetes has usually taken a toll on the patients’ body systems and immunity.

Diabetes weakens the body’s immunity similar to other diseases such as HIV and cancer. In addition, diabetes is not curable and often people need to take medicine for the rest of their lives. If one does not take their medicines, it can cause them more harm, including having more risk of acquiring TB.
There is already a lot of anguish among families and clinicians when they have to deal with diabetic care alone, and just the thought of adding TB care, brings more misery and a lot of burden to the already exhausted social and healthcare system that is grappling to stay afloat.

So, the question is, what can we do? What does this spell for my mother in-law who has been diabetic for more than 20 years? What about my siblings, friends, colleagues, and even our children? What does this mean for the more than one million diabetic patients living in Uganda? What can Uganda do to help this situation not get out of hand?
We can ask and work with the Ministry of Health to increase public awareness about diabetics through media campaigns, community health education and training of health workers. Diabetic patients who have had a cough for at least two weeks should have a sputum sample taken and tested for TB and also get a chest X-ray taken.

If we can hold tightly to the principle of “prevention is better than cure”, now is the time to work smart and do something. We need to actively integrate and plan for TB screening at all diabetic clinics. This will help us identify individuals with TB disease symptoms and signs early and will allow us to treat them promptly and save lives.
If we can save even one Ugandan from all the grief and pain of having both diseases, it will be totally worth every effort!

Dr Biraro is a senior lecturer at the
Department of Internal Medicine School
of Medicine, College of Health Sciences, Makerere University.