Skip to main content
Article thumbnail
Location of Repository

Screening patients with Diabetes Mellitus for Tuberculosis in China.

By Y Lin, L Li, F Mi, J Du, Y Dong, Z Li, W Qi, X Zhao, Y Cui, F Hou, R Zachariah, A Kapur, K Lönnroth and A D Harries


Objective  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, we aimed to assess the feasibility and results of screening DM patients for TB within the routine healthcare setting of five DM clinics. Method  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, and we 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. Results  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. Conclusion  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

Year: 2012
DOI identifier: 10.1111/j.1365-3156.2012.03069.x
OAI identifier:
Provided by: MSF Field Research

Suggested articles


  1. (2010a) Defining the research agenda to reduce the joint burden of disease from Diabetes mellitus and Tuberculosis.
  2. (2010b) The HIVassociated tuberculosis epidemic – when will we act?
  3. (2008). Adapting the DOTS Framework for Tuberculosis Control to the Management of Non-Communicable Diseases in sub-Saharan Africa.
  4. (2011). Applying lessons learnt fromthe ‘‘DOTS’’TuberculosisModel tomonitoring and evaluating personswith diabetesmellitus in Blantyre,Malawi.
  5. (2010). Bi-directional screening for tuberculosis and diabetes: a systematic review.
  6. (2007). Diabetes and the risk of tuberculosis: a neglected threat to public health.
  7. (2008). Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies.
  8. (2012). Diabetes saps health and wealth from China’s rise.
  9. (2011). IDF Diabetes atlas. 5th edn. International Diabetes Federation,
  10. (2010). Implications of the global increase of diabetes for tuberculosis control and patient care.
  11. (2011). National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants.
  12. (2011). Organization
  13. (2011). Organization and The International Union Against Tuberculosis and Lung Disease
  14. (2010). Prevalence of diabetes among men and women in China. New England
  15. (2010). Rapid molecular detection of tuberculosis and rifampin resistance.
  16. (2005). Scaling up antiretroviral therapy in Africa: learning from tuberculosis control programmes – the case of Malawi.
  17. (2011). The impact of diabetes on tuberculosis treatment outcomes: a systematic review.
  18. (2012). Timing of antiretroviral therapy for HIV-1-associated tuberculosis.
  19. (2009). Tuberculosis and diabetes mellitus: convergence of two epidemics.
  20. (2010). Using touchscreen electronic medical record systems to support and monitor national scale-up of antiretroviral therapy in Malawi.

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.