Key research questions | Priority | Study design and methodology |
---|---|---|
Screening for Disease:
|
High | Prospective observational cohort studies of DM patients routinely attending diabetes clinics and screened for TB, and TB patients starting anti-TB treatment and screened for DM |
TB treatment outcomes in patients with DM and with non-diabetes hyperglycaemia, including a more detailed assessment of death during anti-TB treatment, and the development and testing of strategies to improve outcomes for both diseases | High | Prospective observational cohort studies using standardised TB regimens and standardised treatment outcomes and focusing on defined primary outcomes Prospective observational cohort studies to determine when death occurs in relation to start of TB treatment, the aetiology and whether case fatality is reduced by better control of DM or hyperglycaemia or modification to TB drug regimens, duration of therapy and TB drug doses |
Implementing and evaluating the “DOTS” model for standardised case management of DM | High | Operational research that includes quarterly cohort reporting of new cases, treatment outcomes of cumulative cases including frequency of co-morbidities such as TB, and survival analysis |
Development and evaluation of better point-of-care diagnostic and monitoring tests for DM | High | Developmental work to produce a reliable low cost finger stick test for measuring blood glucose and glycated haemoglobin A1c (HbA1c) in rural areas, which then needs to be tested for efficacy and feasibility in the field |
Rates of hospitalisation and additional medical costs associated with diagnosis and management of dual disease | Medium | Cross-sectional and case-control studies |
Use of the community to improve diagnosis, management and care of patients with diabetes and TB | Medium | Operational research |
Household contact tracing of adult patients with smear- positive Pulmonary TB | Medium | Prospective observational studies to determine the yield of screening household contacts of index Pulmonary TB patients for TB infection, active TB, HIV and DM, and assess whether DM influences the risk of TB infection |
Radiographic findings in DM patients with tuberculosis | Medium | Systematic review of the literature, and prospective cross-sectional studies if further evidence is required, to determine the common radiographic patterns that are associated with DM |
Modelling the effect of the DM epidemic on the TB epidemic | Medium | Mathematical modelling studies, ideally informed by higher quality studies of the association between DM and TB, particularly from low-income settings |
TB preventive therapy in patients with DM | Low | Randomised controlled trial assessing efficacy and safety of isoniazid preventive therapy in reducing risk of active TB in patients with DM |
DM = diabetes mellitus; TB = tuberculosis; HIV = human immunodeficiency virus