Where do we stand? TANDEM progress during the first eighteen months

In the first eighteen months of the project lifetime, a number of important preparatory tasks have been achieved by all the partner institutes, at each field-site and through collaboration which will enable the completion of the objectives, tasks, milestones and deliverables of the project. Consortium standard operating procedures were agreed, and applications for ethical permission submitted and granted. Equipment and consumables were purchased and new staff hired and trained. Case report forms were developed for electronic capture of data at the field clinics onto tablets, including clinical features and related to socioeconomic status; RedCap was selected as the platform to use for the project databases which are hosted by St Georges Medical School, London.

Sample recruitment for the cross sectional analysis of Type 2 DM in TB patients and TB in Type 2 DM patients, was initiated and around 25% of the planned 1500 TB patients have been recruited by the four field partners in Indonesia, Peru, Romania and South Africa. In addition, 1086 diabetes patients have been screened for Mycobacterium tuberculosis (Mtb) infection (100% recruited). Results for the first TB patients show prevalence figures for DM ranging from 4% to 22 % in the four sites. Moreover, the first 16 patients have been recruited for the randomised controlled trial of normal practice compared to more intensive monitoring of Type 2 DM patients to improve glycaemic control and clinical outcomes. In the TB patients being screened for DM, we are comparing a risk score, random blood glucose measurement and HbA1c as diagnostic tests for DM. Sample collection for the longitudinal study analysis of gene expression changes through TB therapy, in patients with TB alone or with TB and Type 2 DM, are now being collected and banked for later analysis. More mechanistic studies of the interactions between diabetes and Mycobacterium tuberculosis infection are ongoing. Preliminary results to date indicate that the infection by and survival of Mtb in human monocyte-derived macrophages is not affected by hyperglcaemia although there were effects on cytokine secretion; the human adipocyte cell strain SGBS showed signs of insulin resistance when infected by Mtb; and that Mtb could be found in perigonadal fat pads from mice infected with Mtb via the aerosol route.

Looking back at the first eighteen months also shows that consortium partners have been engaged in a vivid and fruitful exchange with cooperation working well from the onset. Following the ‘Kick-off’ meeting held in April 2013 at the Coordinating Institution in London, project members have been keen on seizing every opportunity for exchange and networking among each other, so that sub-group meetings and small face-to-face meetings in conjunction with larger conferences have been frequent. Communication systems have evolved, including regular teleconferences and email correspondence, as well as Skype meetings. The second annual consortium meeting was held at Stellenbosch University in Cape Town in April 2014. This provided the opportunity for a field visit to one of the local patient recruitment sites (local hospital) and the site’s own lab. This was of specific interest for the representatives of the remaining field sites and led to a fruitful exchange on best practices regarding the implementation of patient recruitment and processing of patient samples. Given the beneficial nature of this visit, the consortium decided to hold the subsequent 2015 annual meeting at another field site, which is Padjadjaran University in Bandung, Indonesia.

The first one and a half years of the TANDEM project has shown promising developments and consortium members are excited about their joint endeavor to eventually produce results that will contribute to scientific and health policy advances on key issues related to combined TB and DM. The entire team is committed to make this goal a reality and will keep pushing forward to make TANDEM a success.