A Double Burden India Can’t Ignore: Tackling TB and Diabetes Together

What if two silent epidemics were colliding to create a public health crisis right under our noses? In India, millions grapple with health challenges shaped by changing lifestyles and persistent infectious diseases, yet few realize how these forces intertwine. Over 27 lakh new cases of a preventable lung infection and 75 million adults living with a chronic metabolic condition signal an urgent need for awareness. This dual burden, affecting urban and rural communities alike, demands attention to protect lives and reduce strain on healthcare systems.

The Twin Burden: TB and Diabetes in India

India bears the world’s highest burden of tuberculosis (TB) while also witnessing a sharp rise in diabetes cases. The connection between the two is striking—individuals with diabetes are significantly more likely to develop TB. Research in India consistently shows a high prevalence of diabetes among TB patients, with rates increasing further in older age groups.

This overlap reflects more than coincidence—it is a classic example of a syndetic, where two diseases interact and worsen each other’s impact. TB, caused by Mycobacterium tuberculosis, spreads through the air and primarily affects the lungs, though it can damage other organs. Diabetes, marked by persistently high blood sugar due to insulin resistance or deficiency, weakens the immune system, making it harder for the body to fight infections like TB.

The relationship runs both ways. Diabetes compromises immune defences, tripling the risk of developing active TB. On the other hand, TB triggers inflammation and physiological stress that disrupt blood sugar control, often leading to uncontrolled hyperglycaemia during treatment. This bidirectional cycle is particularly evident in India’s rapidly urbanising states, where lifestyle shifts are contributing to the rise of both conditions.

Why This Matters: Health Outcomes and Treatment Challenges

TB–diabetes comorbidity in India carries grave consequences. Studies, including findings from the Indian Council of Medical Research (ICMR)–India Diabetes (INDIAB) study, show that TB patients with diabetes face a markedly higher risk of death, increased chances of treatment failure, and poorer overall outcomes compared to those without diabetes.

The risks are fuelled by India’s dual health burdens—TB thrives in overcrowded, poorly ventilated, and malnourished settings, while diabetes is driven by sedentary lifestyles, high-refined-carb diets, obesity, and genetic predisposition. Poorly managed diabetes can mask TB symptoms, delay diagnosis, and increase the likelihood of latent TB turning active.

Patients with both diseases face treatment failure rates greater relapse risk, and higher chances of drug resistance due to diabetes-related immune suppression. This strains healthcare systems, especially in underserved regions, and worsens outcomes amid overlapping health crises.

Integrated care is critical. TB drugs can interact with diabetes medications, requiring careful dose adjustments and glucose monitoring. Yet, gaps remain—frontline workers often lack training for bidirectional screening, and primary centres face resource shortages. Strengthening protocols to jointly address TB and diabetes is essential to improve survival and recovery.

What Can Help: Pathways to Mitigate the Dual Threat

• Integrated Screening Protocols: Implementing routine Bidirectional screening for TB and diabetes in both public and private health settings is critical to early detection and timely intervention.
• Capacity Building at the Frontline: Healthcare workers across primary health centres and private clinics must be trained to manage the dual burden effectively, including treatment coordination and follow-up.
• Holistic Patient Management: Coordinated management—addressing glycaemic control alongside TB treatment—can improve outcomes. Monitoring for cardiovascular risks and ensuring uninterrupted drug supply are key.
• Strengthening Health Information Systems: Better data on TB-Diabetes comorbidity, treatment outcomes, and regional prevalence can guide policy and resource allocation.
• Community Awareness Campaigns: Educating communities about how managing one condition can affect the other can boost adherence to treatment and promote preventive habits.

Conclusion

The convergence of tuberculosis and diabetes in India presents a critical public health challenge—one that magnifies illness severity, complicates treatment, and increases the risk of death. This dual burden is fuelled by overlapping socio-economic, lifestyle, and environmental factors, making integrated, bidirectional screening and management essential. Strengthening frontline capacity, closing diagnostic gaps, and tailoring treatment to address both conditions simultaneously are no longer optional—they are imperative. Only through coordinated, multidisciplinary action can India hope to curb the deadly synergy between TB and diabetes and protect its most vulnerable populations.

Inaction is not an option. A coordinated response today can save thousands of lives tomorrow.

Dr. Ravi N. Sangapur, Consultant Internal Medicine ,HCG Suchirayu Hospitals.