When ancient and modern diseases collide: evidence from Kiribati on the link between diabetes and tuberculosis

Tuberculosis (TB) an ancient bacterial disease with potentially deadly consequences continues to ravage communities in the Asia-Pacific region. High rates continue to be recorded in many countries, including in Timor Leste, Cambodia, Myanmar, Papua New Guinea, Kiribati and Marshall Islands. The association between TB and diabetes has been known for centuries. As far back as the 11th century, the Persian scholar, Avicenna, documented that phthisis (the Latin word for TB of the lungs or a wasting disease) frequently complicated diabetes. This association was forgotten about for many years, except that a small group of European and American doctors continued to write on the subject in the 1950s and 1960s. From the 1980s onwards, and in the wake of the HIV epidemic, global health policy makers quite rightly focused their attention on the deadly combination of TB and HIV co-infection, and the implementation of TB-HIV collaborative activities. More recently, the association between TB and diabetes has once again come into focus, partly due to the recognition that diabetes is increasing and that people from both high and low income countries are affected.