16 July 2019

People with diabetes have a higher chance of getting tuberculosis (TB) and worldwide diabetes is now responsible for >10% of the tuberculosis epidemic. People with diabetes have a more than 3-fold increased risk of developing tuberculosis. Diabetes is also associated with more severe tuberculosis, and more deaths and failing treatment. More than 400 million people worldwide have diabetes and this number is increasing rapidly, especially in countries where TB is endemic.Relatively little is known about the effects of diabetes on TB in Africa.
 
Reinout van Crevel and Lindsey te Brake have received European funding (4,8 million euros) to lead an international consortium to screen thousands of people with diabetes in Uganda and Tanzania for TB, and investigate the effect and costs of 3 months preventive treatment for TB.
 
Tuberculosis affects> 10 million people annually and more than 1 million people die from the disease. Moreover, an estimated one quarter of the world's population is infected with Mycobacterium tuberculosis and they have a lifelong risk of getting active tuberculosis.
It is impossible to reduce tuberculosis without paying attention to the large group with "latent tuberculosis infection".  High-risk groups such as small children and HIV-infected people are therefore already being treated preventively. People with diabetes could be a logical next group, but this has not yet been investigated.
 
In recent years, Reinout van Crevel has led a major international initiative "TANDEM" (which stands for "tuberculosis and diabetes mellitus") with a combination of clinical studies in Africa, Peru, Romania and Indonesia, and laboratory research in Radboudumc and other laboratories. TANDEM has provided many new insights, for example with regard to the greatly increased risk of tuberculosis with the combination of diabetes and latent tuberculosis. And now the work of TANDEM can be continued with this large - and first - clinical trial to investigate preventive treatment for TB in people with diabetes, including looking at screening, costs, quality of care and epidemiological effects of diabetes on TB in Africa.

Reinout van Crevel and Lindsey te Brake are members of theme Infectious diseases and global health.

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