There is a high burden of both diabetes (DM) and tuberculosis (TB) in
China, and as DM increases the risk of TB and adversely affects TB
treatment outcomes, there is a need for bidirectional screening of the
two diseases. How this is best performed is not well determined. In this
pilot project in China, the authors aimed to assess the feasibility and
results of screening DM patients for TB within the routine healthcare
setting of five DM clinics.
Agreement on how to screen, monitor and record was reached in May 2011
at a national stakeholders meeting, and training was carried out for
staff in the five clinics in July 2011. Implementation started in
September 2011. This is a report on 7 months of activities up to 31
March 2012. DM patients were screened for TB at each clinic attendance
using a symptom-based enquiry, and those positive to any symptom were
referred for TB investigations.
In the three quarters, 72% of 3174 patients, 79% of 7196 patients and
68% of 4972 patients were recorded as having been screened for TB,
resulting in 7 patients found who were already known to have TB, 92 with
a positive TB symptom screen and 48 of these newly diagnosed with TB as
a result of referral and investigation. All patients except one were
started on anti-TB treatment. TB case notification rates in screened DM
patients were several times higher than those of the general population,
were highest for the five sites combined in the final quarter (774/100
000) and were highest in one of the five clinics in the final quarter
(804/100 000) where there was intensive in-house training, special
assignment of staff for screening and colocation of services.
This pilot project shows that it is feasible to carry out screening of
DM patients for TB resulting in high detection rates of TB. This has
major public health and patient-related implications.
Lin, Y.; Li, L.; Mi, F.; Du, J.; Dong, Y.; Li, Z.; Qi, W.; Zhao, X.; Ciu, Y.; Hou, F.; Zachariah, R.; Kapur, A.; Lonnroth, K.; Harries, AD. Screening patients with Diabetes Mellitus for Tuberculosis in China. Tropical Medicine and International Health (2012) 17 (10) 1302-1308. [DOI: 10.1111/j.1365-3156.2012.03069.x]
Screening patients with diabetes mellitus for tuberculosis in China.