As diabetes cases soar, health experts are warning that cases of tuberculosis (TB) are likely to rise as well, creating a global "co-epidemic."
People with diabetes, it turns out, are two to three times more likely to get TB because diabetes suppresses the immune system.
"We want to raise an alarm that we don't watch history repeat itself," Anthony Harries of the International Union Against Tuberculosis and Lung Disease told Reuters, referring to a similar co-epidemic of tuberculosis and HIV that arose in the 1980s.
Diabetes already affects 382 million people, and is projected to affect 592 million by 2035, according to the International Diabetes Federation.
"A person sick with both diseases is likely to have complications that do not typically exist when either is present on its own," according to a report from the recent Union World Conference on Lung Health, NPR reports.
"Obviously diabetes does something to your immunity, but we don't understand what," Harries told NPR. "We're trying to understand the mechanisms."
Being sick with both diseases makes treatment tricky, NPR reports, because the drugs for diabetes and for TB don't interact well together.
"This makes it more difficult to treat TB," Harries said. "There's an increased chance of relapse and death, and it takes longer to go from infectious to non-infectious. And controlling diabetes [also] becomes more difficult."
Countries with high rates of TB include Brazil, China, India, Indonesia and the Russian Federation. Countries at the highest risk of a co-epidemic are typically poorer, but no country would be immune, NPR noted.
"I think there was the belief that diabetes occurred in rich people in rich countries and tuberculosis occurred in poor people in poor countries," Harries told the Australian Broadcasting Corporation. "I think we're coming to realize that's not so."
Complicating an already murky issue, half of the people in the world with diabetes don't know they have it until they get so sick that they develop complications such as kidney or heart failure.
To combat the lack of awareness, the report recommended "bi-directional screening." In other words, if you have TB, get tested for diabetes — and vice versa.