Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis

Background 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. Main text 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. Conclusions 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. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Kerama, Cheryl [verfasserIn] Horne, David Ong’ang’o, Jane Anzala, Omu

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2023

Schlagwörter:	Tuberculosis Dysglycaemia Diabetes Prediabetes HIV END TB 2035 NCDs

Anmerkung:	© The Author(s) 2023

Übergeordnetes Werk:	Enthalten in: Bulletin of the National Research Centre - Berlin : Springer, 2018, 47(2023), 1 vom: 13. Apr.
Übergeordnetes Werk:	volume:47 ; year:2023 ; number:1 ; day:13 ; month:04

Links:	Volltext

DOI / URN:	10.1186/s42269-023-01029-6

Katalog-ID:	SPR050036882

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520			\|a Background 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. Main text 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. Conclusions 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.
520			\|a Key points 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.
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700	1		\|a Horne, David \|4 aut
700	1		\|a Ong’ang’o, Jane \|4 aut
700	1		\|a Anzala, Omu \|4 aut
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allfields	10.1186/s42269-023-01029-6 doi (DE-627)SPR050036882 (SPR)s42269-023-01029-6-e DE-627 ger DE-627 rakwb eng Kerama, Cheryl verfasserin (orcid)0000-0001-5892-7966 aut Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Background 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. Main text 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. Conclusions 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. Key points 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. Tuberculosis (dpeaa)DE-He213 Dysglycaemia (dpeaa)DE-He213 Diabetes (dpeaa)DE-He213 Prediabetes (dpeaa)DE-He213 HIV (dpeaa)DE-He213 END TB 2035 (dpeaa)DE-He213 NCDs (dpeaa)DE-He213 Horne, David aut Ong’ang’o, Jane aut Anzala, Omu aut Enthalten in Bulletin of the National Research Centre Berlin : Springer, 2018 47(2023), 1 vom: 13. Apr. (DE-627)1035877007 (DE-600)2946659-3 2522-8307 nnns volume:47 year:2023 number:1 day:13 month:04 https://dx.doi.org/10.1186/s42269-023-01029-6 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 47 2023 1 13 04
spelling	10.1186/s42269-023-01029-6 doi (DE-627)SPR050036882 (SPR)s42269-023-01029-6-e DE-627 ger DE-627 rakwb eng Kerama, Cheryl verfasserin (orcid)0000-0001-5892-7966 aut Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Background 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. Main text 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. Conclusions 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. Key points 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. Tuberculosis (dpeaa)DE-He213 Dysglycaemia (dpeaa)DE-He213 Diabetes (dpeaa)DE-He213 Prediabetes (dpeaa)DE-He213 HIV (dpeaa)DE-He213 END TB 2035 (dpeaa)DE-He213 NCDs (dpeaa)DE-He213 Horne, David aut Ong’ang’o, Jane aut Anzala, Omu aut Enthalten in Bulletin of the National Research Centre Berlin : Springer, 2018 47(2023), 1 vom: 13. Apr. (DE-627)1035877007 (DE-600)2946659-3 2522-8307 nnns volume:47 year:2023 number:1 day:13 month:04 https://dx.doi.org/10.1186/s42269-023-01029-6 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 47 2023 1 13 04
allfields_unstemmed	10.1186/s42269-023-01029-6 doi (DE-627)SPR050036882 (SPR)s42269-023-01029-6-e DE-627 ger DE-627 rakwb eng Kerama, Cheryl verfasserin (orcid)0000-0001-5892-7966 aut Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Background 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. Main text 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. Conclusions 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. Key points 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. Tuberculosis (dpeaa)DE-He213 Dysglycaemia (dpeaa)DE-He213 Diabetes (dpeaa)DE-He213 Prediabetes (dpeaa)DE-He213 HIV (dpeaa)DE-He213 END TB 2035 (dpeaa)DE-He213 NCDs (dpeaa)DE-He213 Horne, David aut Ong’ang’o, Jane aut Anzala, Omu aut Enthalten in Bulletin of the National Research Centre Berlin : Springer, 2018 47(2023), 1 vom: 13. Apr. (DE-627)1035877007 (DE-600)2946659-3 2522-8307 nnns volume:47 year:2023 number:1 day:13 month:04 https://dx.doi.org/10.1186/s42269-023-01029-6 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 47 2023 1 13 04
allfieldsGer	10.1186/s42269-023-01029-6 doi (DE-627)SPR050036882 (SPR)s42269-023-01029-6-e DE-627 ger DE-627 rakwb eng Kerama, Cheryl verfasserin (orcid)0000-0001-5892-7966 aut Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Background 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. Main text 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. Conclusions 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. Key points 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. Tuberculosis (dpeaa)DE-He213 Dysglycaemia (dpeaa)DE-He213 Diabetes (dpeaa)DE-He213 Prediabetes (dpeaa)DE-He213 HIV (dpeaa)DE-He213 END TB 2035 (dpeaa)DE-He213 NCDs (dpeaa)DE-He213 Horne, David aut Ong’ang’o, Jane aut Anzala, Omu aut Enthalten in Bulletin of the National Research Centre Berlin : Springer, 2018 47(2023), 1 vom: 13. Apr. (DE-627)1035877007 (DE-600)2946659-3 2522-8307 nnns volume:47 year:2023 number:1 day:13 month:04 https://dx.doi.org/10.1186/s42269-023-01029-6 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 47 2023 1 13 04
allfieldsSound	10.1186/s42269-023-01029-6 doi (DE-627)SPR050036882 (SPR)s42269-023-01029-6-e DE-627 ger DE-627 rakwb eng Kerama, Cheryl verfasserin (orcid)0000-0001-5892-7966 aut Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis 2023 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier © The Author(s) 2023 Background 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. Main text 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. Conclusions 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. Key points 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. Tuberculosis (dpeaa)DE-He213 Dysglycaemia (dpeaa)DE-He213 Diabetes (dpeaa)DE-He213 Prediabetes (dpeaa)DE-He213 HIV (dpeaa)DE-He213 END TB 2035 (dpeaa)DE-He213 NCDs (dpeaa)DE-He213 Horne, David aut Ong’ang’o, Jane aut Anzala, Omu aut Enthalten in Bulletin of the National Research Centre Berlin : Springer, 2018 47(2023), 1 vom: 13. Apr. (DE-627)1035877007 (DE-600)2946659-3 2522-8307 nnns volume:47 year:2023 number:1 day:13 month:04 https://dx.doi.org/10.1186/s42269-023-01029-6 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER GBV_ILN_11 GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_70 GBV_ILN_73 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_171 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_370 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4335 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 47 2023 1 13 04
language	English
source	Enthalten in Bulletin of the National Research Centre 47(2023), 1 vom: 13. Apr. volume:47 year:2023 number:1 day:13 month:04
sourceStr	Enthalten in Bulletin of the National Research Centre 47(2023), 1 vom: 13. Apr. volume:47 year:2023 number:1 day:13 month:04
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Tuberculosis Dysglycaemia Diabetes Prediabetes HIV END TB 2035 NCDs
isfreeaccess_bool	true
container_title	Bulletin of the National Research Centre
authorswithroles_txt_mv	Kerama, Cheryl @@aut@@ Horne, David @@aut@@ Ong’ang’o, Jane @@aut@@ Anzala, Omu @@aut@@
publishDateDaySort_date	2023-04-13T00:00:00Z
hierarchy_top_id	1035877007
id	SPR050036882
language_de	englisch
fullrecord	<?xml version="1.0" encoding="UTF-8"?><collection xmlns="http://www.loc.gov/MARC21/slim"><record><leader>01000naa a22002652 4500</leader><controlfield tag="001">SPR050036882</controlfield><controlfield tag="003">DE-627</controlfield><controlfield tag="005">20230414064818.0</controlfield><controlfield tag="007">cr uuu---uuuuu</controlfield><controlfield tag="008">230414s2023 xx \|\|\|\|\|o 00\| \|\|eng c</controlfield><datafield tag="024" ind1="7" ind2=" "><subfield code="a">10.1186/s42269-023-01029-6</subfield><subfield code="2">doi</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(DE-627)SPR050036882</subfield></datafield><datafield tag="035" ind1=" " ind2=" "><subfield code="a">(SPR)s42269-023-01029-6-e</subfield></datafield><datafield tag="040" ind1=" " ind2=" "><subfield code="a">DE-627</subfield><subfield code="b">ger</subfield><subfield code="c">DE-627</subfield><subfield code="e">rakwb</subfield></datafield><datafield tag="041" ind1=" " ind2=" "><subfield code="a">eng</subfield></datafield><datafield tag="100" ind1="1" ind2=" "><subfield code="a">Kerama, Cheryl</subfield><subfield code="e">verfasserin</subfield><subfield code="0">(orcid)0000-0001-5892-7966</subfield><subfield code="4">aut</subfield></datafield><datafield tag="245" ind1="1" ind2="0"><subfield code="a">Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis</subfield></datafield><datafield tag="264" ind1=" " ind2="1"><subfield code="c">2023</subfield></datafield><datafield tag="336" ind1=" " ind2=" "><subfield code="a">Text</subfield><subfield code="b">txt</subfield><subfield code="2">rdacontent</subfield></datafield><datafield tag="337" ind1=" " ind2=" "><subfield code="a">Computermedien</subfield><subfield code="b">c</subfield><subfield code="2">rdamedia</subfield></datafield><datafield tag="338" ind1=" " ind2=" "><subfield code="a">Online-Ressource</subfield><subfield code="b">cr</subfield><subfield code="2">rdacarrier</subfield></datafield><datafield tag="500" ind1=" " ind2=" "><subfield code="a">© The Author(s) 2023</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Background 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. Main text 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. Conclusions 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.</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Key points 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.</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Tuberculosis</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Dysglycaemia</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Diabetes</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Prediabetes</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">HIV</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">END TB 2035</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">NCDs</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Horne, David</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Ong’ang’o, Jane</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Anzala, Omu</subfield><subfield code="4">aut</subfield></datafield><datafield tag="773" ind1="0" ind2="8"><subfield code="i">Enthalten in</subfield><subfield code="t">Bulletin of the National Research Centre</subfield><subfield code="d">Berlin : Springer, 2018</subfield><subfield code="g">47(2023), 1 vom: 13. 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author	Kerama, Cheryl
spellingShingle	Kerama, Cheryl misc Tuberculosis misc Dysglycaemia misc Diabetes misc Prediabetes misc HIV misc END TB 2035 misc NCDs Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis
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topic_title	Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis Tuberculosis (dpeaa)DE-He213 Dysglycaemia (dpeaa)DE-He213 Diabetes (dpeaa)DE-He213 Prediabetes (dpeaa)DE-He213 HIV (dpeaa)DE-He213 END TB 2035 (dpeaa)DE-He213 NCDs (dpeaa)DE-He213
topic	misc Tuberculosis misc Dysglycaemia misc Diabetes misc Prediabetes misc HIV misc END TB 2035 misc NCDs
topic_unstemmed	misc Tuberculosis misc Dysglycaemia misc Diabetes misc Prediabetes misc HIV misc END TB 2035 misc NCDs
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title	Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis
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title_full	Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis
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title_sort	rethinking the syndemic of tuberculosis and dysglycaemia: a kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis
title_auth	Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis
abstract	Background 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. Main text 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. Conclusions 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. Key points 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. © The Author(s) 2023
abstractGer	Background 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. Main text 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. Conclusions 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. Key points 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. © The Author(s) 2023
abstract_unstemmed	Background 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. Main text 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. Conclusions 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. Key points 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. © The Author(s) 2023
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title_short	Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis
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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. Main text 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. Conclusions 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.</subfield></datafield><datafield tag="520" ind1=" " ind2=" "><subfield code="a">Key points 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.</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Tuberculosis</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Dysglycaemia</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Diabetes</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Prediabetes</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">HIV</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">END TB 2035</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">NCDs</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Horne, David</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Ong’ang’o, Jane</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Anzala, Omu</subfield><subfield code="4">aut</subfield></datafield><datafield tag="773" ind1="0" ind2="8"><subfield code="i">Enthalten in</subfield><subfield code="t">Bulletin of the National Research Centre</subfield><subfield code="d">Berlin : Springer, 2018</subfield><subfield code="g">47(2023), 1 vom: 13. 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Rethinking the syndemic of tuberculosis and dysglycaemia: a Kenyan perspective on dysglycaemia as a neglected risk factor for tuberculosis

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