Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis.
Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis.
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DOI：
10.1186/s42269-023-01029-6
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发表时间：
2023
影响因子：
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通讯作者：
Anzala, Omu
中科院分区：
文献类型：
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作者：
Kerama, Cheryl;Horne, David;Ong'ang'o, Jane;Anzala, Omu
从非传染性疾病（NCD）控制与结核病（TB）相互作用的角度来看，低收入和低/中等收入国家（LIC和LMIC）的2035年结核病终结目标还有很长的路要走。世界卫生组织已确定糖尿病是结核病的决定因素，也是一个重要但被忽视的风险因素。国家指南规定了检测时间点，但这些时间点往往是在一个孤立的时间点，而不是在一段时间内。本文旨在透视结核病和代谢异常的综合征相互作用，以及解决这两个问题的差距如何阻碍实现2035年结核病终结的进展。 糖化血红蛋白（HbA 1C）与后续糖尿病的进展有很强的预测关联。因此，在结核病初始治疗时，使用该方法进行筛查可能是一种很好的筛查方法，而不是仅使用随机血糖或空腹血糖。HbA 1C具有观察到的死亡风险梯度，使其成为结局的信息预测因子。确定从诊断到治疗结束以及治疗结束后不久的血吸虫病进展可能提供有关筛选和随访的最佳时间点的信息。尽管结核病和人类免疫缺陷病毒（艾滋病毒）疾病的治疗是免费的，但隐藏的费用仍然存在。如果伴随有代谢异常，这些费用是累加的。无论是否接受结核病治疗，据估计，几乎一半的肺结核患者会发展为结核后肺部疾病（PTLD），而血吸虫病的贡献还没有得到很好的描述。确定单独治疗结核病合并糖尿病/前驱糖尿病以及艾滋病毒合并感染的费用，将使决策者了解治疗这些患者和补贴营养不良症护理在财政上需要什么。在肯尼亚，心血管疾病是仅次于传染病的死亡原因，糖尿病是心脏病的一个众所周知的风险因素。在贫穷国家，传染病是造成死亡的主要原因，但社会变迁和农村向城市的移徙可能是造成非传染性疾病明显增加的原因。从非传染性疾病控制的角度来看，2035年消除结核病目标在低收入国家和低收入国家还有很长的路要走。世卫组织已将糖尿病确定为结核病的一个重要和被忽视的风险因素。贫困是医疗保健的障碍。在全球范围内，2019年，几乎一半的结核病患者及其家庭面临灾难性的成本（定义为总成本相当于家庭年收入的20%以上），对于有耐药结核病成员的家庭，这一比例高达80%。尽管结核病和艾滋病毒医疗保健是“免费”的，但隐性成本仍然存在，对家庭产生了深远的社会经济影响。即使采用治愈性治疗，也有近一半的肺结核患者会发展为结核后肺病（PTLD），而血吸虫病的贡献尚未得到很好的描述。虽然糖尿病和结核病之间的关系得到了很好的描述，但对两者之间的代谢异常谱的研究却没有得到很好的描述。尽管大多数中低收入国家（LMC和LMIC）严重依赖国际捐助资金，但结核病研究的资金已经下降到不到目标的一半。
The END TB 2035 goal has a long way to go in low-income and low/middle-income countries (LICs and LMICs) from the perspective of a non-communicable disease (NCD) control interaction with tuberculosis (TB). The World Health Organization has identified diabetes as a determinant for, and an important yet neglected risk factor for tuberculosis. National guidelines have dictated testing time points, but these tend to be at an isolated time point rather than over a period of time. This article aims to give perspective on the syndemic interaction of tuberculosis and dysglycaemia and how the gaps in addressing the two may hamper progress towards END TB 2035. Glycated haemoglobin (HbA1C) has a strong predictive association with the progression to subsequent diabetes. Therefore, screening using this measure could be a good way to screen at TB initiation therapy, in lieu of using the random blood sugar or fasting plasma glucose only. HbA1C has an observed gradient with mortality risk making it an informative predictor of outcomes. Determining the progression of dysglycaemia from diagnosis to end of treatment and shortly after may offer information on the best time point to screen and follow-up. Despite TB and Human Immunodeficiency Virus (HIV) disease care being free, hidden costs remain. These costs are additive if there is accompanying dysglycaemia. Regardless of receiving TB treatment, it is estimated that almost half of persons affected by pulmonary TB develop post-TB lung disease (PTLD) as an outcome and the contribution of dysglycaemia is not well described. Establishing costs of treating TB with diabetes/prediabetes alone and in the additional context of HIV co-infection will inform policy makers on what it takes, financially, to treat these patients and subsidize dysglycaemia care. In Kenya, cardiovascular disease is only rivalled by infectious disease as a cause of mortality, and diabetes is a well-described risk factor for cardiac disease. In poor countries, communicable diseases are responsible for majority of the mortality burden, but societal shifts and rural–urban migration may have contributed to the observed increase of NCDs. The END TB 2035 goal has a long way to go in LICs and LMICs from a non-communicable disease (NCD) control perspective. The WHO has established diabetes as an important and neglected risk factor for TB. Poverty is a barrier to healthcare. Globally, in 2019, almost half of all people with TB and their households faced catastrophic costs (defined as total costs equivalent to > 20% of annual household income) and rising up to 80% for those households with a member having drug-resistant TB. Though TB and HIV healthcare is ‘free’, hidden costs remain which have far-reaching socio-economic effects on households. Even with curative treatment, nearly half of persons affected by pulmonary TB develop post-TB lung disease (PTLD) as an outcome and the contribution of dysglycaemia is not well described. While the relationship between diabetes and TB is well described, the work on the dysglycaemia spectrum in between is not as well described. Funding for TB research has fallen below less than half of target despite most low to low/middle income (LMCs and LMICs) being heavily reliant on international donor funding.