Otago researchers in major new study of TB and diabetes

Otago researchers in major new study of TB and diabetes epidemics

University of Otago expertise is set to play a key role in European Commission (EC) funded research into links between infectious and non-communicable diseases – in this case tuberculosis (TB) and type 2 diabetes.

The EC has earmarked €6 billion for health research under its Seventh Framework Programme (FP7) for the funding of research and technological development, of which €6 million (NZ$9.5 million) has been awarded to the new project.

Co-Director of the University’s Centre for International Health, Professor Philip Hill, says the initial call was for projects that combine one of the three major poverty-related diseases – HIV/AIDS, malaria and tuberculosis – with the major non-infectious diseases including rheumatic or cardiovascular disease, cancer and diabetes.

“This year nine million people will be diagnosed with TB and up to 1.4 million will die from it. We also know that just under 400 million people live with diabetes and around 10 - 20% of new cases of TB are also diabetic, which is a much higher percentage than you would expect by chance,” Professor Hill says.

“There are more TB cases with diabetes than there are with HIV and while diabetes doesn't have as dramatic an effect on TB as HIV does, it is clearly a significant player - presumably through an effect on the immune system. The fact that the number of people worldwide with diabetes is increasing at an alarming rate will have an effect on global TB control.”

Professor Hill, who has an extensive record in TB research in developing countries, will be part of a multi-disciplinary consortium linking field sites in four TB-endemic countries that are experiencing a rapid growth of type 2 diabetes – namely Romania, Peru, South Africa and Indonesia.

The €6 million (NZ$9.5 million) project, which will be known as TANDEM (Tuberculosis and Diabetes ­Mellitus), will see Otago researchers collaborating with leading laboratories in Germany, UK, Netherlands and Romania. The project’s official start date is 1 February 2013.

The consortium’s aim is to increase knowledge of the causative links between the two diseases and by doing that develop better prevention, treatment and management of them so that mortality rates can be reduced and quality of life improved.

Professor Hill, who was part of the team that designed the study, says the consortium wants to test the hypothesis that screening and management can be greatly improved and simplified with a major impact on the control of TB and diabetes co-morbidity.

“We will explore how best to screen people with TB for diabetes and we will also be able to give an indication, across continents, of the actual proportion of TB patients who also have diabetes, and their basic characteristics.”

TANDEM will also examine the best medications and treatments for TB in this group of patients and explore what their long-term requirements are in terms of diabetes treatment once they have finished their TB treatment.

The study will also look at the effect of glucose control on TB treatment outcome and also look for immune system abnormalities and genetic variations common to both diseases.

Professor Hill says one of the great plusses of a multi-site study like this is the greater statistical power it provides. The researchers will end up with 1500 - 2000 TB cases to study and of those, around 350-400 will also have diabetes.

Otago will be particularly involved in the study based in Indonesia, as part of their formal collaboration with Padjadjaran University, and that study alone will provide about 400 TB cases.

“It is a great privilege to be involved in a European Union study,” says Professor Hill.

“We couldn’t apply on our own; we needed to be part of a consortium and offer something that is not easily available within the EU. Our previous field studies in TB and our growing collaboration with Padjadjaran University provides that.”

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