13 1 General Introduction Figure 3: Incidence and death due to diabetes mellitus in Sub-Saharan African countries from 1990 to 2019 (Global Burden of Disease 2022; https://vizhub.healthdata.org/gbd-results/). To mitigate the impending diabetes crises in Sub-Saharan Africa and other low-resource settings, understanding the drivers of diabetes and identifying other less-known risk factors can provide a critical starting point for designing context-specific interventions [21,26]. Another consideration is determining how the epidemiology of diabetes and other NCDs vary in the context of highly prevalent infectious diseases such as HIV, malaria, and TB. This can inform joint NCD-infectious disease intervention strategies and identify service integration points, lowering healthcare service delivery costs and increasing patient access to infectious diseases and NCD services. Diabetes Mellitus – Tuberculosis Comorbidity Diabetes is a known risk factor for TB. The risk of developing TB is two to three times higher in individuals with diabetes than in those without diabetes, and the risk of death during treatment and relapse after treatment is also higher in people with diabetes [27]. Globally, about 15% of people receiving treatment for TB have diabetes [28,29]. In SubSaharan Africa, the prevalence of DM–TB comorbidity is 6.7 – 15% [28–30]. In diabetes, there is impaired blood glucose regulation, limiting lymphocyte functions and rendering individuals susceptible to reactivation of latent TB and new infections [31]. Complications associated with diabetes, including renal impairment, may contribute to poor TB treatment outcomes in people with diabetes receiving treatment for tuberculosis [25].
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