Public Health Action

of the two diseases, treatment of persons with dual disease and prevention of TB in persons with DM.5 For each of these challenges, the knowledge gaps are highlighted along with the research questions that need to be answered if care and control of the dual burden of disease are to be achieved. The second review article looks at existing and new technologies for screening and diagnosing type 2 DM that may be more suitable for TB patients in lowand middle-income countries.6 As pointed out, these new technologies should be low cost, rapid, easy to use, non-invasive, requiring minimal additional infrastructure and able to differentiate between transient and longer term hyperglycaemia. Several tools in development, such as point-of-care glycated haemoglobin and glycated albumin assays, non-invasive advanced glycation end (AGE) product readers and sudomotor function-based screening devices, are discussed. The eight operational research papers assess 1) bidirectional screening of the two diseases in one facility,7 2) screening of DM patients for TB in one facility,8 and 3) screening of TB patients for DM in the other facilities,9–14 with one of these facilities also evaluating treatment outcomes.13 A few key messages that are consistent across sites emerge. First, the yield of diabetes was high among TB patients, with higher yields seen among patients aged more than 35–40 years, patients with smear-positive pulmonary TB, current cigarette smokers and those with recurrent TB. The proportion with newly diagnosed DM as a result of blood test screening was higher among TB patients managed in peripheral health facilities compared to tertiary care centres, highlighting the need to prioritise active screening efforts at the peripheral level. Second, the yield of TB among DM patients was relatively low, and further research is required to optimise the screening criteria and diagnostic algorithms for diagnosing TB. One study showed that DM patients who were male, older, had a longer duration of DM, required combined oral hypoglycaemic drugs and insulin medication and had poorly controlled DM were more likely to have TB.7 Third, while the results reported are useful, the one study that assessed treatment outcomes was not adequately powered to answer the question about whether DM adversely affects outcomes.12 There was a statistically non-signifi cant trend towards failure of DM-TB patients to smear convert at 2 months, but this whole area requires adequately powered, prospective cohort research. Interna onal Union Against Tuberculosis and Lung Disease Health solu ons for the poor