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POLITICS OF DIABETES IN NIGERIA

The recent series of tweets by the USA senator and presidential aspirant, Senator Bernie Sanders, ‘attacking’ insulin makers, that followed a letter sent by him and his counterpart in the House of Representatives to the Department of Justice and Federal Trade Commission on the need for investigating insulin makers for price collusion was a result of his identification with diabetes (which runs in his family) especially during his campaign for Democrats nomination.

Bernie is not the only USA politician advocating on behalf of the People Living with Diabetes (PWD) , Senator Jenne Shaheen who is the leader of the US Senate Diabetes Caucus was quoted to be committed to ensuring that diabetes is a ” priority for legislation no matter what happens in the election” of 2012.  Her commitment could also be linked to her identification with her diabetic granddaughter.

Moreover, the revelation by the UK Prime Minister, Theresa May, on her Type 1 diabetes status in addition to the functional relationship between the UK Parliament and several diabetes groups in the UK points to the fact that fight for the people with diabetes is a major cause for UK politicians. The act of identifying with diabetes and other non communicable diseases by politicians is a common trend across the developed countries, and this has propelled them to advocating, legislating and making policies for the education, prevention, diagnosing and management of diabetes mellitus in their respective countries.

One of the tweets by Bernie Sanders on his twitter handle @sensanders reads “in the richest nation in the world diabetes patients are being forced to decide between eating and paying for the drugs they need”.

I was prompted to respond by comparing the condition of the people with diabetes (PWD) in poor and unstable nations with those in rich countries that are being sympathised with.

Also, my reaction to the letter by Bernie and his colleague on insulin price is by asking for who are to be the defenders for the “weak and helpless” people living with type 1 diabetes (PWT1D) in poor countries like Nigeria.

My last response was inspired by the attitude of politicians across Africa especially Nigeria where disclosure of true health status of politicians seems abominable whether they are being affected by common diseases or not.

Their practice is to embark on medical tourism to developed countries for treatment and management of such diseases secretly  while people only engage in speculation about their health status . For instance, former President Olusegun Obasanjo was forced to disclose his battle with diabetes over several number of years by his need to get votes for his successor who later died in government due to a then undisclosed ailment. This was at the tail end of his (Obasanjo) eight year tenure.

The failure of Nigerian politicians to identify with non-communicable diseases especially diabetes, by which many of them are believed to be affected, and their ability to travel abroad for treatment make them not to have any inspiration or encouragement to make any specific serious legislation, policy or advocacy that is needed to support the common people on the care and management of diabetes, as many are being afflicted and killed by the disease due to their helplessness.

This is evident in the absence of any specific health policy or program on diabetes, lack of appropriate medical facilities for diagnosis and care, inadequate funding for non-communicable diseases, shortage of diabetes specialists and caregivers, inadequate education on prevention and management of diabetes, absence of any parliamentary resolution on diabetes and absence of any regulation on access to and price of diabetic drugs, (especially insulin) among others.

However, according to International Diabetes Federation (IDF), as at year 2015 out of 415 million people living with diabetes in the world, 75 percent are in the poor and middle income countries with Sub-Sahara Africa accounting for 14.2 million . It is shown that prevalence rate of diabetes in Nigeria is 1.9 percent for adults and 3 out of 100,000 children while around 949, 900 persons are undiagnosed. Among 5 million people that die due to diabetes annually across the world Nigeria accounts for more than 40,000. Relatively, Nigeria leads in the number of incidence of and mortality rate from the disease in Africa.

Meanwhile, the current economic condition, a result of economic recession, in the country is making self management of diabetes unaffordable for the people living with diabetes.

The reliance on importation of all the much needed diabetic supplies,  continuous fall in the exchange rate of Naira to foreign currencies, galloping inflation and dwindling real income have all contributed to unaffordability and inaccessibility of the supplies most especially insulin.

The price of each of the items has skyrocketed to about 150 percent increase within a short period of eight months. Choosing myself as a typical sample of an average  person living with diabetes in the country , my monthly costs of supplies currently within Lagos metropolis could be broken down as follows :

Insulin ( Mixtard of 100 IU)              N5500 per vial

Syringes                                                       N2500 per pack of 100 units

Glucometer (Accu-chek Active)    N8000

Meter test strips                                    N4600 per pack

Diabetic multivitamin                        N3400

All these prices are only obtainable within Lagos which is the major commercial city in the country, but in other cities and towns most of the supplies are either much more costlier or not totally available. Meanwhile , my monthly income stands at around N25000 out of which I spend around N16000 on the supplies (64 percent) . The cost of transportation and other implicit costs are yet to be included.

Despite all the available statistics on diabetes, though actually underestimated because of absence of credible medical data gathering in the country, and the plight of the people living with diabetes in managing the condition there is no any serious political will on the part of policy makers, and in spite of signing up with Global Action on Non-communicable diseases, to help the people with diabetes out of the challenges being faced in the need to lead fulfilled lives, and reduce the level prevalence of the disease.

Nigeria is only chosen in this article as a reflective sample for all the poor and politically unstable countries of the world, which means that the conditions of the people living with diabetes in these countries, especially in Africa, need urgent and serious actions on the part of their politicians on supports for adequate management as well as on the need for measures for prevention to reduce the rate of prevalence.

So, the question still remains as who will fight for the ‘weak and helpless’ people living with diabetes in the poor countries?

Olafimihan Nasiru Titilope is living with diabetes can be reached on nasoola77@yahoo.com

 

The article posted is strictly the responsibility of the author. NGdoc  will not be liable for any errors, omissions, or any losses, injuries, or damages arising from its display or use. This article is featured on an as-is basis.

TYPE[1]WRITER TO FACILITATE INSULIN ACCESS TO NIGERIAN CWDS

This was the start of a beautiful friendship and the creation of our diabetes project. Back in 2013 I had the pleasure of meeting Adejumo Hakeem from Nigeria.

We’d been in constant communication prior to the International Diabetes Federation Conference in Melbourne as I’d managed to win their essay competition, ‘Diabetes in Nigeria: Protecting the Future’.

I even went on to write my masters on ‘The Relationship Between Urbanisation and Type 2 Diabetes: a human rights-based approach to health in Nigeria’. So here we were, online friends from New Zealand and Nigeria, finally able to cross the ocean and meet in person.

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It’s been 6 months since the book was launched and the sales are still doing great. The profits from my book go directly to Adejumo at NGdoc to aid children with type 1 diabetes in Nigeria who do not have access to the supplies they need to survive. There are already stories of young children who we, and our consumers, have supported. If you have bought a book – YOU helped a child!

Our very first child was enough to spur us on, the fact that we’d made a difference in someone’s life is very humbling. Oluwatimileyin Daniel was 14 years old and in a state of diabetes ketoacidosis in hospital as his family had no money to buy insulin. Through our partnership we were able to pay for both the insulin and glucometer test strips he needed. He was lucky, many are not.

If you want to help us make a difference you can buy the book, or the cheaper e-book version on Amazon. If your child has type 1 diabetes they will hopefully love the book and be saving another child at the same time

Culled from type1writerblog 

Carrie Hetherington can be contacted here

DIABETES AND HEALTHY LIVING – THE TWENTY-FIRST CENTURY BATTLE

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Few decades ago, I moulded sand castles as kid, rolled abandoned car tyres around street corners, woke up each morning to the crowing of the cock – life was serene and unperturbed.

As the world has evolved and technology has improved, computer games have fast replaced outdoor games; kids now learn even their basic nursery rhymes on ‘iPads’.
Loud zooms of fast-moving cars, blaring of horns, footsteps of workers hurrying out before dawn to beat traffic to work has taken over the function of my alarm clock. Welcome to the 21st century!

The “fast and furious” demands of the 21st century are not without their tolls on our health; recourse to a sedentary lifestyle, increased stress level, on-the-go meals to say the least.

One of the most devastating effects of our new way of life in this century is the increase in the number of people being diagnosed with diabetes. Diabetes is a disease of the body’s ability to appropriately utilize sugar, the primary metabolic fuel.

It is a major health concern of the world we live in today, affecting about 400 million people worldwide and accounting for about 5 million deaths annually from its complications which include problems with but not limited to the kidneys (Diabetic nephropathy), eyes (Diabetic retinopathy), nerves (Diabetic neuropathy), poor wound healing, and the heart.

The world’s population has grown from 6.2 billion to about 7 billion in the last decade putting an untold pressure on food production. The resultant effect is production of more processed and synthetic food, making healthy diet more expensive on the average.

Obesity being one of the biggest risk factors of diabetes, hence, healthy diet is of paramount importance. Leafy vegetables, fresh fruits, whole grains cereals, lean meat, fish and nuts should be incorporated.

Corporate organisations now carry out much of their work in virtual offices,many staffers of such organisations do a lot of their tasks on the computer than around the office space. “Work” now colloquially refers to sitting behind a desk pressing the computer all day.

Sedentary life style is another big risk factor. Regular exercise is key. Work-out frequently. Why don’t you try walking down the road for ten minutes before calling a cab,when you go to work tomorrow and subsequently.

Take the “#bigbluetest” as often as you can.
We have deadlines to beat and targets to meet daily. We often need ready-made refreshments or other energy source. Take water or unsweetened coffee instead of processed fruit juice or carbonated drinks.

Peanut butter instead of chocolate or jam spread on bread, nuts and freshly-made fruit juice or sugar-free yoghurt for snacks instead of hamburger and ‘coke’.
Avoid simple sugars
Do not skip breakfast; this is associated with weight gain. Rather, go for smaller ration par meal with a healthy breakfast being pivotal. Choose whole grain bread over white bread, brown rice to replace white rice, whole grain pasta instead of processed ones.

The internet has become part of the fabric of our everyday life. Its use elevates dopamine (the juice of addiction) levels just like cocaine does.

We all are guilty as our devices are never really more than one foot away. The wrong use of the social network has made antisocial beings out of us. Before checking what you have missed online, take some aerobics.

More importantly, monitor your weight and blood sugar level from time to time as early diagnosis and prompt management is central to good prognosis. Whether diabetic or pre-diabetic, living healthy in the 21st century,even with its demands on our health is possible, though a difficult battle, its also winnable.

Join an advocacy group to promote awareness through social media. Take a “blue-circle selfie” and tag along your tweets. Let us propagate the message together and we shall stand tall.

The winning Essay written by Omole Temitope @omoleMD

WORLD DIABETES DAY EVENTS 2014

The World Diabetes Day is celebrated every year on November 14. The World Diabetes Day campaign is led by the International Diabetes Federation and its member association worldwide.

The World Diabetes Day was created in 1991 by the International Diabetes Federation and the World Health Organization in response to the growing concerns about the escalating health threats that Diabetes poses.
World Diabetes Day became an official United Nations Day in 2007 with the passage of The United Nations Resolution 61/225. The campaign draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public spotlight.

The World Diabetes Theme for 2014-2016 is HEALTHY LIVING AND DIABETES.

(The information above is culled from the International Diabetes Federation website. For more information on The International Diabetes Federation visit here)

To celebrate the 2014 World Diabetes Day; The Nigeria Diabetes Online Community (NGdoc) will be involved in series of National and International Programs listed below. Kindly participate in these events happening online and offline.

1) The Nigeria Diabetes Online Community World Diabetes Day Essay runs from November 1- November 10, 2014. Visit here for more info.

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2) The Nigeria Diabetes Online Community World Diabetes Day Diabeducation Program. This year NGdoc will partner with The Ogun State Ministry of Health, Nigeria to train a cross section of about 110 senior secondary school students on diabetes advocacy.

This program to be attended by The Commissioners of Health and Educaton, The Special Adviser to the Ogun State Governor on Health and Chief Olumuyiwa Talabi, the founder and patron of Talabi Diabetes Center Iperu amongst other eminent guests will also herald the launch of the School Health Cadet program of The Ministry of Health, Ogun State.
Follow NGdoc on twitter for updates.

3) The World Diabetes Day 24hour Twitter chat is the 3rd edition of the much anticipated 24 hour twitter chat on the 14th of November hosted by Cherise Shockley of the Diabetes Community Advocacy Foundation. This program features 24 moderators who will each handle the chat hourly from 0.00 EST to 24:00EST.

This chat event has had over 500 participants globally in previous editions. NGdoc will be one of the moderators and thus we’d be hosting an hour. Follow the hashtag #WDDChat14 for more information on moderators, timing and theme of the chat. Visit DCAF website here.

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4) Our official partners The Access Alliance is Putting the world back in The World Diabetes Day by campaigning for access to Insulin for All. You can participate by you sharing a photo of yourself with the inscription boldly written “LETS PUT THE WORLD BACK IN WORLD DIABETES DAY #INSULIN4ALL” Visit here to take part.

5) The Diabetes Hand Foundation  will from 1pm-4pm EDT on November 3 discuss the unmet needs of Diabetes in a twitter chat with The Food and Drug Adninistration (FDA) Follow the hashtag #DOCasksFDA to participate and visit DHF website here.

Join the Diabetes Hand foundation movement by taking the Big Blue Test right now. Each Big Blue Test entry you log between October 20th and November 19th triggers a $1 donation on your behalf to nonprofit groups that are providing life-saving supplies, services and education to people with diabetes in need. Taking the Big Blue Test is easy.

1. Test your blood glucose.  If you do not have diabetes, you can skip this step.

2. Get active.  For 14 to 20 minutes, get up and get moving.  You can , walk, run, clean the house, swim, tap dance…whatever!

3. Test again.  On average, Big Blue Testers seen their blood glucose level drop 20% after 14-20 minutes of exercise.

4. Share your results.  Answer the questions in the right column of this page. And don’t forget to talk about your experience on social media. Visit here for more infobbt-hashtag

 

 

6) Our partner 100campaign 100voices for diabetes aims at bringing together 100 Globalvoices who will advocate for access to insulin. Visit here to include your voice.

EVENTS PENDING CONFIRMATION BY US

Diabetes Community Outreach to the Students of Babcock University at Ilishan, Ogun State, Nigeria. The second edition of this program holding this year aims at Diabetes Education and screening of students of The Babcock University. Follow us on twitter for more information on the date.

A community outreach with The National Youth Service Corp Members of Oyo State, Nigeria. . Follow us on twitter for more information on the date and venue.

IDF POSTERS NOW IN OUR LOCAL LANGUAGES

We are excited to have the International Diabetes Federation Posters in our local languages. We believe these posters will go a long way to educate Nigerians most especially those in rural areas.

These posters are good for popular locations in the community like Churches, Mosques, Town Halls, Market squares, recreation centers and cultural centres.

If you are interested in making these posters available in your community, kindly send us an email thengdoc@gmail.com.

Below are the snapshots and thanks to our translators who made this possible.

WDD Hausa 1

WDD Hausa 2

WDD Hausa 3

WDD Hausa 4

WDD Yoruba 4

WDD Ibo 1

WDD Ibo 2

WDD Ibo 3

WDD Ibo 4

WDD Yoruba 1

WDD Yoruba 2

WDD Yoruba 3

Thanks to the International Diabetes Federation and our Awesome Translators: Oyewusi Oluwafemi, Chukuma Arinze and Zainab Mahmoud.

NOW LETS GET THE MESSAGE ACROSS NIGERIA!

More about The IDF can be seen here

THE AFRICA DIABETES CONGRESS (YAOUNDE 2014)

The Africa Diabetes Congress of the International Diabetes Federation took place at the Palaise de Congress in Yaounde Cameroun from the 25th to the 28 February 2014.

Palaise de Congress
Palaise de Congress

 

The 2nd African Diabetes Congress appropriately themed: “Diabetes: Challenges and opportunities in Africa” provided an ideal opportunity for researchers, health care providers, practitioners, students, people living with diabetes to cross fertilize with colleagues from Africa and mingle with international renowned experts in the field of diabetes.

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About 1,000  participants from about 45 countries were there to raise awareness on diabetes and its impact by convening at the IDF Africa diabetes congress to exchange research and best practices on diabetes prevention, treatment and management.

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 Cross section of Participants at the ADC2014

The international Diabetes Federation (I.D.F) is the umbrella body organization of over 200 national diabetes associations in over 160 countries. It represents the interests and the growing numbers of people with diabetes and those at risk. The Federation has been leading the global diabetes community since 1950.

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Cross-section of participants at the pre-congress post graduate course on Research Methodology/Scientific writing

 A Pre-congress update course on Research Methodology/Scientific writing where about 30 young researchers from all over Africa were trained and updated on recent trends in research methodologies and scientific writing.

According to the Chairman organizing committee and former International Diabetes Federation, President Professor Mbanya the young scientists are expected to through the training received translate diabetes research and care in Africa to meet up to global standard. 

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 Discussing the challenges facing diabetes care in Africa over lunch

Simultaneously, a pre-conference update course on Advocacy was running where selected individuals from different countries attended and were trained on how to advocate, engage the government and ensure right policies are effected in their respective countries .

Policy advocacy is one of the most effective ways to achieve public health goals by ensuring that necessary resources, policies and political will are available to support, scale up, and sustain diabetes efforts within broader NCD programs.

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 Mobolaji Dauda from Nigeria and Pamela Donggo from Uganda at the Update course

We strongly believe that this congress will be one that wont be quickly forgotten as it laid a solid foundation not just for subsequent congresses but also diabetes research, prevention and care in Africa generally.

The 2nd Africa Diabetes Congress was made bilingual through an impressive translation efforts of the Medical Students of the University of Yaounde (a feat that was very professional and commendable).

The Organizers through the efforts of the platinum sponsors were able to sponsor about 600 participants for the congress, a remarkable and great achievement.

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With recent announcement of the startoff of the Africa Diabetes Study Group and Africa Diabetes Journal we are rest assured that IDF Africa through the ADC is positioning itself for the task of curbing the diabetes epidermic in the continent.

We wish to appreciate the congress organizers who through the support of El-Lilly were able to fully sponsor 2 members of The Nigeria Diabetes Online Community for the pre-congress update course and congress and also through Servier provided accommodation for 4 members of The Nigeria diabetes online community for the period of the congress.

We believe supports like this is important in not just building young researchers but also inspiring more youths into diabetes care and prevention in their respective communities all over africa.

PHOTO SPEAKS

NgdocADC2014POST GRADUATE COURSE IN RESEARCH METHODS AND SCIENTIFIC WRITING

 

IMG_0882SHOWCASING THE RICH TRADITIONAL CULTURE OF CAMEROON

 

NGdocADC2014THE OPENING CEREMONY OF THE 2ND AFRICA DIABETES CONGRESS

IMG_0856OPENING CEREMONY WITH THE MINISTER OF PUBLIC HEALTH OF CAMEROON

IMG_0857GUEST LECTURE BY GEORGE ALBERTI (UK)

 

DSC03814ONE OF THE SCIENTIFIC SESSIONS

IMG_0851ONE OF THE SCIENTIFIC SESSIONS

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PROF MBANYA ADMONISHING THE NGDOC TEAM AT THE LILLY DIABETES CONVERSATION MAP STAND

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DIABETES WALK

 

20140226_230203-1NIGERIAN DELEGATES TO THE ADC WITH PROF TOM JOHNSON (4TH FROM THE LEFT)

 

DSC03850YOUNG RESEARCHERS FROM AFRICA

 

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LILLY HOSTED US TO A DINNER

 

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GALA NIGHT

 

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The next Africa diabetes congress will be hosted by Uganda. UGANDA 2016

DIABETES MELLITUS AND TUBERCULOSIS

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TUBERCULOSIS: THE ISSUE IN DIABETES 

Tuberculosis (TB) is an airborne disease caused by infection with Mycobacterium tuberculosis complex (M. tuberculosis, M. bovis, and M. africanum).

Tuberculosis is a major public health problem in many low- and middle-income countries, where the number of people with diabetes is also rising rapidly. Regions, such as Africa and Asia that are most heavily affected by tuberculosis are also those that have some of the highest numbers of people with diabetes, and will experience the biggest increases by 2030.

GROWING DOUBLE BURDEN 

Clinicians have observed an association between Diabetes Mellitus (DM) and TB for centuries, as far back as the ancient Roman times, even though they were unable to determine whether DM caused TB or whether TB led to the clinical manifestations of DM.

The growing prevalence of diabetes poses a challenge for TB control as uncontrolled diabetes leads to a greater risk of developing TB. A recent study showed that countries that saw an increase in diabetes prevalence also had a significant increase in the number of people with TB. This suggests that increasing diabetes prevalence could make attainment of the Millennium Development Goals on tuberculosis more difficult to achieve.

These trends reflect the important links between the diseases. Several studies have looked at the association between diabetes and tuberculosis in developed countries and found that people with diabetes are almost 3 times more likely to develop tuberculosis. These findings were also true of developing regions including Africa where one study found that the prevalence (%) of diabetes was twice as high in people with tuberculosis than in people without tuberculosis.

TUBERCULOSIS

Experimental studies investigating the relationship between Tuberculosis and Diabetes have demonstrated that DM is indeed positively associated with TB.  Studies revealed consistent evidence for an increased risk of TB among people with diabetes despite heterogeneity in study design, geographic area, underlying burden of TB, assessment of exposure and outcome, and control of potential confounders. In addition, DM patients have a significantly increased risk of developing active TB, three times higher than in persons without DM.

BATTLE AGAINST TWO

The relationship between DM and TB is bidirectional. These diseases often coexist. Suboptimal control of diabetes predisposes the patient to tuberculosis, and is one of the common causes of poor response to anti-Tuberculosis treatment. Diabetes impacts TB by:

  1. Tripling the rate of developing active TB from latent TB infection
  2. Increasing mortality and severity of disease
  3. Slowing the response to effective TB treatment.

TB and its treatment can worsen glycemic control and diabetes-related neuropathy. Tuberculosis also affects diabetes by causing hyperglycemia and causing impaired glucose tolerance. Impaired glucose tolerance is one of the major risk factors for developing diabetes.

THE DUO TO WORRY ABOUT

At the individual level, the risk of developing TB is considerably lower in persons with DM than in HIV patients. However, the much larger and rapidly growing pool of DM patients makes the global population of persons with TB and DM very similar to that seen with HIV.

In a study conducted on the United States-Mexico border, it was shown prospectively that DM contributed to 25% of TB cases whereas HIV infection contributed to ≤5%; hence as with TB-HIV, we must adapt and apply similar methods of preventing, screening and treating DM-TB patients, and ensure that we have a secure pipeline for drugs that will improve the efficacy of treatment.

WISDOM WAY OUT

The Pacific Standards for Management of Tuberculosis and Diabetes lay out a framework for the bi-directional screening for each disease when one is present, as well as provides guidance on testing, patient support, active and preventive TB treatment. This framework may be useful for other regions, and should be considered for the proper management of TB and DM.

Suggested screening for M. tuberculosis infection can be  achieved using QuantiFERON®-TB Gold In-Tube test (QFT®), along with a symptom review for prompt diagnosis and treatment of TB or latent TB infection (LTBI).  QFT has been shown to be significantly more accurate than the skin test, only requires one visit, and does not cross-react with the BCG vaccine. However QFT or the skin test do not distinguish between Latent TB Infection  and active disease, hence active TB must be excluded before starting preventive therapy.

QFT, like the skin test is an  indirect test for M. tuberculosis infection (including disease) and is intended for use in conjunction with risk assessment, radiography and other medical and diagnostic evaluations.  (QuantiFERON-TB Gold ELISA Package Insert, 2013).  Clinical assessment is always needed. Hence, active or latent TB should never be diagnosed or excluded on the sole basis of the QFT or skin test result.

This write-up was put together by Akinpelu Akintunde, a final year medical student of Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria.

REFERENCES

  1. The International Diabetes Federation
  2. Banyai A (1931) Diabetes and pulmonary tuberculosis. Am Rev Tuberc 24: 650-667.
  3. Root H (1934) The association of diabetes and tuberculosis. New Engl J Med 210: 1-13.
  4. Boucot KR, Dillon ES, Cooper DA, Meier P, Richardson R (1952) Tuberculosis among diabetics: the Philadelphia survey. Am Rev Tuberc 65: 1-50.
  5. Nichols GP (1957) Diabetes among young tuberculosis patients; a review of the association of the two diseases. Am Rev Tuberc 76: 1016-1030.
  6. Silwer H, Oscarsson PN (1958) Incidence and coincidence of diabetes mellitus and pulmonary tuberculosis in a Swedish county. Acta Med Scand Suppl 335: 1-48.
  7. Kim SJ, Hong YP, Lew WJ, Yang SC, Lee EG (1995) Incidence of pulmonary tuberculosis among diabetics. Tuber Lung Dis 76: 529-533.
  8. Pablos-Mendez A, Blustein J, Knirsch CA (1997) The role of diabetes mellitus in the higher prevalence of tuberculosis among Hispanics. Am J Public Health 87: 574-579.
  9. Ponce-De-Leon A, Garcia-Garcia Md Mde I., Garcia-Sancho MC, Gomez-Perez FJ, Valdespino-Gomez JL., et al. (2004) Tuberculosis and diabetes in southern Mexico. Diabetes Care 27: 1584-1590.
  10. Alisjahbana B, van Crevel R, Sahiratmadja F, den Heijer M, Maya A (2006) Diabetes mellitus is strongly associated with tuberculosis in Indonesia. Int J Tuberc Lung Dis 10: 696-700.

10. Perez A, Brown HS 3rd, Restrepo BI (2006) Association between tuberculosis and diabetes in the Mexican border and non-border regions of Texas. Am J Trop Med Hyg 74: 604-611.

11. Christie Y Jeon, Megan B. Murray (2008) Diabetes mellitus increases the risk of active tuberculosis: A systematic review of 13 observational studies. PLoS Med 5(7): e152.

12. Asfandyar Khan Niazi and Sanjay Kalra (2012) Diabetes and tuberculosis: a review of the role of optimal glycemic control. Journal of Diabetes & Metabolic Disorders 2012, 11:28.

13. Pacific Island TB Control Association (2013) USA Pacific Standards for the Management of Tuberculosis and Diabetes. http://www.currytbcenter.ucsf.edu/abouttb/TB_DM_USAPI_Standards_document_12_01_2010.pdf.

14. QuantiFERON-TB Gold (QFT) ELISA Package Insert. July 2013.