Обратная связьCountries are encouraged to scale up access to diabetes testing and management to reach the global targets for diagnosis and glycaemic control of diabetes as agreed at the World Health Assembly and with the aim of achieving UHC (88,89). Scale-up of diabetes services will also contribute to ending TB.
Evidence from several studies suggests a dose–response relationship between glycated haemoglobin (HbA1C) and the risk of TB disease, indicating that improving glycaemic control in people with diabetes might reduce the risk of developing TB (4,94,97,99). A systematic review of the effect of oral glucose-lowering drugs on the risk of TB incidence found that, in contrast with other oral glucose-lowering drugs, the use of metformin compared with no-metformin use, resulted in a 40% reduced risk of TB (relative risk, 0.60; 95% confidence interval, 0.47 ; 0.77) (131). Because of considerable heterogeneity among the studies, however, the review authors concluded that the results should be interpreted with caution and should be tested further in well-designed randomized controlled trials (131). An increased risk for TB has also been reported among people being treated for diabetes. The authors hypothesized that people with more severe diabetes have to take glucose-lowering drugs, including insulin, and that it is the severity of diabetes that increases the risk for TB (132,133).
As part of TB prevention, people living with diabetes should be counselled about their higher risk of TB disease (and other bacterial infections) when they are diagnosed with diabetes. They should be provided with information on the symptoms and signs of TB and where to go for advice or testing if they have any concern (e.g. local clinics and services). For further details on TB screening and diagnosis, see section 3.1. Health-care workers should be trained and equipped to provide health education to people with diabetes.
