Friday , April 23 2021

The time is now to review diabetic clinical care



The world celebrated World Diabetes Day on November 14, with an emphasis on "family and diabetes." As a physician working in one of Uganda's public hospitals, my heartfelt empathy goes to more than one million diabetic patients and their families living in Uganda. These brave souls have to deal with this disease daily during their lives. They face many complications with their kidneys, heart, eyes, nerves, to name a few. But there is a complication that has been silent over the years and is now emerging as a force to be faced; the notorious disease called tuberculosis (TB).

Diabetics are at high risk of being infected with tuberculosis. Every three of the 10 patients with diabetes will have an active disease of tuberculosis. Diabetics who contract tuberculosis are more likely to die of tuberculosis than those with individual diseases – their tuberculosis takes longer to heal, they have problems controlling blood sugar levels, and overall, it's much poorer quality of life.

This is probably not news to many people, so why does it matter now? Some may argue that we know from time to time that tuberculosis disease is a known complication of diabetes. So why the hype now? What has changed?
Numbers! On the one hand, the number of diabetics has tripled or quadrupled and, on the other hand, there has been an increase in the number of cases of tuberculosis in our communities, which has increased the risk of contracting tuberculosis. In fact, many people with tuberculosis are lost!
Another thing that has changed is the geographic and socioeconomic distribution of diabetes disease. At the clinic, we are seeing many rural people developing diabetes.

Many "poor" Ugandans are having diabetes due to rising poor living habits. Many Ugandans eat more unhealthy foods rich in sugar and unsaturated fats from fast-growing fast food places, but also from street vendors, including the famous "Rolex." Many are having less active lives, and most can not afford routine medical checkups that help catch diabetes illness earlier. So, unfortunately, by the time it is detected, diabetes often affects patients' body systems and immunity.

Diabetes weakens the body's immunity, similar to other diseases, such as HIV and cancer. In addition, diabetes is not curable and often people need to take medicine for the rest of their lives. If someone does not take their medicines, this can cause more harm, including a higher risk of getting TB.
There is already a lot of anguish between families and doctors when they have to deal only with diabetic care, and only the idea of ​​adding TB care brings more misery and too much burden to the already exhausted social and health system that is struggling to stay to the fore.

So the question is, what can we do? What does this mean for my mother-in-law who has been diabetic for more than 20 years? And my brothers, friends, colleagues and even our children? What does this mean for the more than one million diabetic patients living in Uganda? What can Uganda do to help this situation not get out of control?
We can ask and work with the Ministry of Health to raise public awareness about diabetics through media campaigns, community health education and training of health professionals. Diabetic patients who have had a cough for at least two weeks should have a sputum sample taken and tested for TB and also have a chest x-ray.

If we can firmly adhere to the principle that "prevention is better than cure", now is the time to work smart and do something. We need to actively integrate and plan TB screening in all diabetic clinics. This will help us identify individuals with symptoms and signs of TB quickly and allow us to treat them promptly and save lives.
If we can save even a Ugandan from all the sadness and pain of having both diseases, it will be worth every effort!

Dr. Biraro is a senior lecturer at the
Department of Internal Medicine
of Medicine, Faculty of Health Sciences, Makerere University.


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