Hall of Fame hockey player Wayne Gretzky had a famously successful strategy: don’t skate to the puck, skate to where the puck is heading.
Public health officials should take a page from The Great One’s book when it comes to a looming co-epidemic of tuberculosis and diabetes. If we don’t anticipate the challenges-and head them off right now, millions of people are going to lose big time.

In a new study in a leading medical journal The Lancet Diabetes & Endocrinology, a team of researchers from eight countries published a
comprehensive review of studies showing how rising diabetes rates are fueling TB.

{mosads}The researchers analyzed global disease trends, and concluded that current projections put us on a collision course with catastrophe. The number of people living with Type 2 diabetes, in which the body is unable to process insulin, is projected to increase from 382 million in 2013 to as many as 592 million by 2035. If that trend continues, it would effectively sustain the global TB epidemic.

That’s because one in three people worldwide live with a latent TB infection. For most people, this infection will remain dormant their whole lives, never making them sick and never spreading to another person. But if the immune system ever weakens, the chances that the infection will progress to “active” TB disease-which is contagious and can be fatal, skyrocket.

Diabetes weakens the immune system, tripling one’s risk of developing TB. And diabetes is now escalating in areas of the world like Asia and
sub-Saharan Africa, where latent TB infections are highly common. In some high-burden states in India, an estimated 20 percent of TB cases
are already found among people with diabetes.

A global TB-diabetes co-epidemic would be devastating to the tremendous progress we’re making against TB. Globally, the TB mortality rate has been cut nearly in half since 1990 according to the World Health Organization. China has managed to cut the number of cases by half in that same period. The number of people who develop TB each year is falling in most parts of the world.

But TB still remains a devastating disease-the world’s deadliest infectious killer with the exception of HIV/AIDS. There were 8.6 million new TB cases recorded in 2012 and 1.3 million deaths. Sub-Saharan Africa has the world’s highest rates of TB. Now consider that the International Diabetes Federation predicts a 109% increase in diabetes on the African continent in the next two decades. If you accept the basic premise that diabetes fuels the spread of TB, you don’t need to be a mathematician to see the situation quickly turning from bad to worse.

Luckily, a small cadre of dedicated scientists has been painstakingly studying the looming TB-diabetes co-epidemic for years. In 2011, their
efforts culminated in The Collaborative Framework for Care and Control of Tuberculosis and Diabetes, published jointly by the World Health
Organization and the International Union Against Tuberculosis and Lung Disease. This document provides evidence-based guidance for
policymakers and health program implementers to begin addressing the growing epidemic of diabetes and TB.

But like all carefully conceived public health solutions, we need political will to mobilize action-and in most places we’re simply not seeing it, at least not nearly fast enough given the enormity of the problem lying just ahead.

The real kicker is we’ve been here before. Between 1990 and 2005, countries across sub-Saharan saw the number of people falling ill with TB each year quadruple. Eventually health officials realized that HIV/AIDS was fueling the spread of TB, leading the World Health Organization to declare a public health emergency. In countries where the TB-HIV co-epidemic looms large, the norm is now to fight the diseases together. This includes having an integrated public health strategy, as well as health services that screen people with HIV for TB, test people with TB for HIV, and provide appropriate care to people affected by both infections.

But it took far too long to get here-and the cost of delay has been astronomical for people living in countries that have been impacted. In the country of Swaziland, TB-HIV was responsible for reducing average life expectancy by fifty percent.

When it comes to addressing TB-diabetes, we know exactly where the puck is going. If we fail to get out in front of it now, millions of people will face the deadly consequences of an entirely preventable epidemic.

Harries is senior adviser and director of the Department of Research at The International Union Against Tuberculosis and Lung Disease.