TANDEM members at 46th Union World Conference on Lung Health
The 46th Union World Conference on Lung Health, held on December 2-6 in Cape Town, South Africa, provided the platform for some critical scientific revelations and updates promising to have real impact on patients who live with tuberculosis (TB). During the course of the five-day scientific programme, the TB Alliance announced the availability of the first child-friendly TB medicines, studies on the impact of TB on key affected populations were shared and the civil society organized a ‘Together to #EndTB’ march. People who had lived with, through and beyond TB told their real-life stories, which was a moving experience for all of the conference participants.
Several members of the TANDEM Consortium were present at the conference and actively contributed to the programme. In the oral presentation on TB and NCD comorbidity, Sue McAlister gave a talk "Screening for diabetes mellitus in tuvberculosis patients: who should be prioritised" on behalf of Dr Koesoemadinata and the Bandung group. This analysis has shownt that in Indonesia where 5.8% of the population have DM, you needed to treat 24 individuals to fins a new DM case, but in those over 24 but in those who were overweight this reduced to 13.
Sue McAllister and David Moore presented posters on the topics “Performance of glycated hemoglobin (HbA1c) as a screening test for diabetes mellitus in pulmonary tuberculosis” and “High rates of previously known, but poorly controlled diabetes among TB patients in Lima, Peru”.
Other presentations on TB and DM at the Congress included a study from Taiwan showing that diabetes patients had a hazard ratio of 1.62 to develop TB if they had diabetes; this increased to 2.1 of the diabetes was poorly controlled and reduced to 0.66 if it was controlled (P-H. Lee et al); a study from Malawi on comorbidity showing that only 3.5% of those on a Category II retreatment regimen had diabetes (Cohen et al); a large study from Tanzania (Boillet-Blanco et at) with 530 TB patients and 491 controls which found more diabetes and pre-diabetes in the TB patients than the controls, but found that most returned to normal by 5 months on TB treatment (particularly relevant for TANDEM!) a study from Virginia in which TB drug levels were monitored and drug concentrations increased if they were suboptimal, which showed DM patients then had a faster time to sputum conversion (Heysell et al; a large study from Zambia with 39800 TB cases and 6977 controls which only found an Odds Ratio of 1.48 for hypoglycaemia and TB, although this was higher in HIV positive patients (Bailey et al), and a talk by Fiona Person from TANDEM (welcome back Fiona!) on a large dataset from UK Primary Care showing the risk of TB if you had DM was 1.5 for both type 1 and type 2 diabetes, but with a higher risk of DM if you had prior TB, 5.6.