Integrated Management of Diabetes and Tuberculosis in Rural India - Results From a Pilot Study

Rohina Joshi; Deepanjali Behera; Gian Luca Di Tanna; Mohammed Abdul Ameer; Kenneth Yakubu; Devarsetty Praveen

doi:10.3389/fpubh.2022.766847

Integrated Management of Diabetes and Tuberculosis in Rural India - Results From a Pilot Study

Front Public Health. 2022 May 10:10:766847. doi: 10.3389/fpubh.2022.766847. eCollection 2022.

Authors

Rohina Joshi^{1

2

3}, Deepanjali Behera⁴, Gian Luca Di Tanna², Mohammed Abdul Ameer³, Kenneth Yakubu², Devarsetty Praveen^{2

3

5}

Affiliations

¹ School of Population Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
² The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
³ Health Systems Science, The George Institute for Global Health, New Delhi, India.
⁴ KIIT School of Public Health, KIIT University, Bhubaneswar, India.
⁵ Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India.

Abstract

Introduction: The World Health Organization and International Union against Tuberculosis (TB) recommends screening patients with TB for Diabetes Mellitus (DM) at the initiation of treatment. There are few pilot studies which screen TB patients for DM, but none of them have documented the feasibility of managing TB patients with DM in the Indian healthcare setting. Operational research is needed to determine the best way to manage individuals with both conditions. This pilot study aimed to develop, and field test an integrated, multidisciplinary program addressing the management of individuals with TB and DM and other associated chronic conditions in the Indian primary healthcare setting.

Methods: This pilot study used a randomized controlled trial design with mixed-methods evaluation and was conducted in Guntur district of Andhra Pradesh, a southern state of India. All the 120 patients newly diagnosed with TB from 10 participating villages were screened for DM and associated cardiovascular risk factors. Non-physician health workers were trained to follow-up patients for a period of 8 months to encourage treatment adherence, monitor treatment response including blood glucose levels and provide lifestyle advice.

Results: The intervention was well-accepted by the providers and patients. However, there were no statistically significant variations observed for mean blood glucose levels (mean [SD]: 5.3 [-23.3 to 33.8]) of patients for both intervention and control group participants in this feasibility study. Awareness about diabetes and tuberculosis comorbidity and cardiovascular risk increased among the non-physician health workers in the intervention arm of the study.

Discussion: The co-management of TB-DM is acceptable to both the health providers and patients. With appropriate training, availability of infrastructure and planned intervention implementation, it is feasible to co-manage TB-DM within the existing primary health care system in India.

Keywords: delivery of health care (MeSH); diabetes mellitus; feasibility studies; primary health care (MeSH); tuberculosis.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Blood Glucose
Diabetes Mellitus* / diagnosis
Diabetes Mellitus* / epidemiology
Diabetes Mellitus* / therapy
Humans
India / epidemiology
Pilot Projects
Tuberculosis* / complications
Tuberculosis* / epidemiology
Tuberculosis* / therapy

Substances

Blood Glucose